Involved-field Irradiation Intensity Modulated Radiation Therapy with Concurrent Chemotherapy for Locally Advanced Non-small Cell Lung Cancer
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摘要: 目的 比较累及野照射（IFI）和选择性淋巴结照射（ENI）调强放射治疗联合同步化疗治疗局部晚期非小细胞肺癌（LA-NSCLC）的不良反应和疗效。方法49例LA-NSCLC患者前瞻性随机分为IFI组和ENI组，同步化疗两周期，行根治性调强放射治疗。结果IFI组和ENI组≥2级放射性肺炎发生率分别为8.0％和37.5％（P=0.01）；GTV平均剂量分别是（66.2±6.5）Gy和（61.3±6.3）Gy，（P=0.01）；总有效率为92.0％和66.7％（P=0.03）；预防照射区内淋巴结复发率为4.2％和4.0％，（P=0.49）；1年局部失败率分别为8.0％和16.7％（P=0.62）；1年生存率为72.0％和62.5％（P=0.48）。结论IFI同步放化疗治疗LA-NSCLC可降低正常组织并发症的概率，提高靶区照射剂量和肿瘤控制率，预防照射区内淋巴结复发率无增加，有望延长患者生存期。Abstract: Objective To compare toxicities and clinical outcomes of involved field irradiation (IFI)and with elective nodal irradiation (ENI)intensity modulated radiation therapy (IMRT)with concurrent chemotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). Methods 49 patients with of LA-NSCLC were prospectively randomized into IFI group and ENI group，receiving 2 cycles of concurrent chemotherapy and radical IMRT. Results ≥grade 2 radiation pneumonitis developed in 8.0% of the patients in IFI group and 37.5% in ENI group (P=0.01).The mean prescription doses to grass tumor volumes with IFI and ENI were (66.2±6.5)Gy and (61.3±6.3)Gy (P=0.01).The responsive rates were 92.0% and 66.7% (P=0.03)，and the elective nodal failure (ENF)rates were 4.2%and 4.0% (P=0.49)，respectively.The 1-year local-failure rates were 8.0% and 16.7% (P=0.62)，while the 1-year survival rates were72.0% and 62.5% (P=0.48)，respectively. Conclusion IFI IMRT with concurrent chemotherapy for LA-NSCLC could reduce the probability of normal tissue complications and improve the target dose and tumor control rate without increasing incidence of elective nodal failure.It might further prolong patients' survival.
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