局部进展小细胞肺癌患者放疗靶区勾画的临床观察

摘要/Abstract

摘要： 目的探讨局部进展小细胞肺癌患者放疗靶区勾画对疗效与毒副反应的影响。
方法选择2012年10月～2014年10月间收治的初始行化疗治疗后局部进展的小细胞肺癌患者128例，随机分为对照组（n=64）和观察组（n=64）。通过增强CT定位扫描勾画靶区，两组PTVT均为化疗后残留原发灶外扩获得。对照组PTVN为阳性淋巴结引流区外扩摆位误差，观察组PTVN为GTVN外扩摆位误差，PTVT、PTVN处方剂量60 Gy／30次，2 Gy／次，每周5次。比较两组平均肺剂量（MLD）、双肺V20、有效率（RR），并随访患者3年内肿瘤复发情况以及毒副反应。
结果观察组MLD和双肺V20分别为（955±228）Gy和（2165±376）％，均低于对照组的（1275±243）Gy和（2532±423）％，差异具有统计学意义（P＜005）。观察组RR为672％（43／64），对照组为719（46／64），两组差异无统计学意义（P＞005）。两组3年复发率均为1000％。对照组45例患者放射野内复发，19例患者放射野外复发；观察组48例患者放射野内复发，16例患者放射野外复发，两组差异无统计学意义（P＞005）。观察组3级以上的血液学毒性、急性放射性肺炎、体重减轻发生率分别为47％、266％和234％，均低于对照组的188％、547％和516 ％，差异均有统计学意义（P＜005）。
结论PTVN靶区勾画可有效减少化疗后局部进展的小细胞肺癌患者MLD以及双肺V20，对临床疗效和肿瘤复发无影响，并可显著降低毒副反应。

关键词: 小细胞肺癌, 放射治疗, 靶区勾画

Abstract: ObjectiveTo investigate the effect of radiotherapy target area delineation on efficacy and toxicity in locally advanced small cell lung cancer.
MethodsFrom October 2012 to October 2014， 128 patients with locally advanced small cell lung cancer were randomly divided into control group（n=64） and observation group（n=64）. The target areas were identified by enhanced CT localization and scanning. The two groups of PTVT were all expanded after chemotherapy. In the control group， PTVN was defined as a positive lymph node drainage area extending outward. The PTVN in the observation group was the lateral spread error of GTVN. PTVT and PTVN prescription dose was 60 Gy／30 fraction， 2 Gy／f， 5 fractions per week. The mean lung dose （MLD）， double lung V20 and curative effect were compared between the two groups， and the recurrence and toxic reaction of the patients in 3 years were followed up.
ResultsThe observation group MLD and V20 of double lung were （955±228） Gy and （2165±376）％， lower than the control group （1275±243） Gy and （2532±423）％， the difference was statistically significant （P＜005）. The remission rate（RR） in the observation group was 672％（43／64）， while that in the control group was 719 （46／64）. There was no significant difference between the two groups （P＞005）. The 3year recurrence rate of the two groups was 100％. In the control group， 45 cases recurred in the radiation field， and 19 cases recurred out of the radiation field. In the observation group， 48 cases recurred in the radiation field， and 16 cases recurred out of the radiation field. There was no significant difference between the two groups （P＞005）. The observation group of more than 3 hematological toxicity， acute radiationinduced pneumonia， weight loss rate was 47％， 266％ and 234％， were lower than the control group 188％， 547％ and 516％， the differences were statistically significant （P＜005）.
ConclusionTarget delineation （PTVN） can effectively reduce MLD and V20 of double lung of locally advanced small cell lung cancer patients after chemotherapy， had no effect on the clinical efficacy and recurrence of the tumor， and can significantly reduce the adverse reaction.

Key words: Small cell lung cancer, Radiotherapy, Target area delineation

刘颖, 杨红霞, 张坤, 王静, 杨健. 局部进展小细胞肺癌患者放疗靶区勾画的临床观察[J]. 临床肿瘤学杂志, 2018, 23(7): 644-647.

LIU Ying, YANG Hongxia, ZHANG Kun, WANG Jing, YANG Jian. . Clinical observation of radiotherapy target area delineation for locally advanced small cell lung cance[J]. Chinese Clinical Oncology, 2018, 23(7): 644-647.

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