靶向治疗Ⅳ期非小细胞肺癌体积变化及放疗时机选择研究

doi:10.3760/cma.j.cn113030-20200507-00234

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摘要目的探讨驱动基因敏感突变Ⅳ期非小细胞肺癌分子靶向治疗后肿瘤体积变化规律及开始放疗时机。方法采用前瞻性研究方法通过模拟定位CT结果分析治疗前后每隔10d原发肿瘤体积变化。当前后两次体积变化≤5%或治疗90天后终止定位和体积测量并实施放疗,记录放疗急性不良反应,比较实施和模拟放疗计划的相关参数。结果 30例中 29例纳入分析(1例脱落),人表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗后原发肿瘤体积均缩小,但退缩率和速度不一致,至终止定位时最大缩小90%、最小缩小28%;治疗40d内平均体积缩小明显,每间隔10d的平均体积不同(P<0.001);40天后逐渐出现因原发肿瘤体积退缩率≤5%的病例,至90天仅 1例体积退缩>5%,平均体积退缩速度减慢而趋于稳定,退缩率为 49.15%~54.77%;70天平均体积略有增大后又缓慢缩小,每间隔10d的平均体积相近(P>0.05)。终止定位后实施放疗病例的原发肿瘤可给予剂量为(69±7) Gy,发生2、3级急性放射性肺炎和放射性食管炎分别为 2例和 3例、1例和 0例。按照实施放疗计划的技术、剂量参数分别设计EFGR-TKI治疗前和第40天的模拟放疗计划,全部显示实施计划显著优于EGFR-TKI治疗前模拟计划(P均<0.05),而与第40天模拟放疗计划之间相近(P>0.05)。结论 EGFR-TKIs治疗后Ⅳ期非小细胞肺癌的原发肿瘤退缩率随时间推移逐渐减缓,40天内缩小最显著而后缓慢缩小,每一病例的肿瘤退缩速度不一致,治疗后40天开始放疗可能是获得提高剂量并控制放射损伤的最佳时机。

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	张霞
	张毅
	欧阳伟炜
	马筑
	李青松
	胡银祥
	耿一超
	陈霞霞
	李晓阳
	苏胜发
	卢冰

关键词 ：肺肿瘤/靶向疗法, 体积变化, 肺肿瘤/放射疗法, 放疗时机

Abstract：Objective To investigate the primary tumor volume change and timing of radiotherapy for patients with stage Ⅳ non-small cell lung cancer with EGFR mutation during molecular targeted therapy. Methods Simulated CT scanning measurement and analysis were performed to observe the volume changes of primary tumors before and after treatment with a time interval of 10 days in this prospective study. Positioning and volume measurement were terminated when the volume change was 5% or less between two time points before and after treatment or 90 days after treatment. Primary tumor radiation therapy was then performed, acute radiation-induced injury was recorded, and the implementation and simulation of related parameters of radiotherapy plans were compared. Results Twenty-nine of 30 cases were included in the analysis (1 case dropped off). After EGFR-TKIs treatment, the volume of all primary tumors was decreased, but the shrinking rate was inconsistent with the speed. Until the last simulated CT scanning, the maximum and minimum shrinking rates were 90% and 28%, respectively. There was no case of termination within 30 days of treatment, and the average tumor volume was significantly decreased within 40 days and the average tumor volume significantly differed every 10 days (P<0.001). After 40 days, the volume shrinking rate of primary tumors ≤5% gradually appeared, and one patient presented with a volume shrinking rate of >5% on 90 days. During this time, the average volume shrinking rate slowed down and became stable, ranging from 49.15% to 54.77%. Moreover, the average volume continued to gradually shrink after slight increase at 70 days. There was no significant difference in the average volume every 10 days (P>0.05). After the termination of simulated CT scanning, the dose of primary tumor was (69±7) Gy for patients receiving radiotherapy. Two patients had grade 2 acute radiation-induced pneumonitis and 3 patients had grade 3 acute radiation-induced pneumonitis. In addition, 1 patient had grade 2 radiation-induced esophagitis. According to the technology and dose parameters of radiotherapy plan, simulated radiotherapy plans before and 40 days after EGFR-TKIs treatment were designed. The timing of implementation plan was significantly better than that before EGFR-TKIs treatment (all P<0.05), whereas it was similar to that at 40 days after EGFR-TKI treatment (P>0.05). Conclusions The primary tumor shrinking rate is gradually slowed down over time after EGFR-TKIs treatment in patients with stage Ⅳ non-small cell lung cancer. The average tumor volume is significantly decreased within 40 days and then the shrinking rate becomes slow. The tumor shrinking rate of each case is inconsistent. Radiotherapy at 40 days after treatment is probably the optimal timing to obtain high dose and control radiation-induced injury.

Key words： Lung neoplasm/targeted therapy Volume change Lung neoplasm/radiotherapy Timing of radiotherapy

收稿日期: 2020-05-07

基金资助:贵州省科技计划支撑项目[黔科合支撑(2019)2795]

通讯作者: 卢冰,Email:lbgymaaaa@163.com

引用本文:

张霞,张毅,欧阳伟炜等. 靶向治疗Ⅳ期非小细胞肺癌体积变化及放疗时机选择研究[J]. 中华放射肿瘤学杂志, 2020, 29(8): 633-638.

Zhang Xia,Zhang Yi,Ouyang Weiwei et al. Study of volume change and radioherapy timing in patients with stage Ⅳ non-small cell lung cancer by targeted therapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 633-638.

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