3DCRT与IMRT对Ⅲ期NSCLC剂量学及疗效比较

doi:10.3760/cma.j.issn.1004-4221.2015.02.000

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摘要目的比较Ⅲ期NSCLC采用3DCRT与IMRT疗效及肿瘤靶区剂量分布。方法回顾分析419例行3DCRT 或IMRT的Ⅲ期NSCLC资料,其中340例3DCRT、79例IMRT,中位处方剂量60 Gy (范围50~76 Gy)。140例单纯放疗、279例放化疗。采用DVH参数评价靶区剂量分布,Kaplan-Meier法计算OS率并Logrank法检验。结果一般临床资料相比,IMRT组比3DCRT组的年龄偏大、N期和临床分期偏晚(P=0.01、0.00、0.00);靶区剂量体积参数相比,IMRT组比3DCRT组的PTV更大(P=0.01),CTV的D_mean、D₉₀和PTV的D_mean、V₆₅~V₆₀明显小(P=0.03、0.05、0.01、0.01、0.04),双肺V₅~V₂₀、食管D_mean、野内食管长度、LET50~LET55和脊髓D_mean均明显高(P=0.00、0.00、0.03、0.02、0.00、0.00、0.00、0.00、0.01、0.00)。随访率97.4%,全组放疗后1、3、5年OS率和中位生存期分别为65.5%、26.1%、18.5%和20个月。IMRT组与3DCRT的OS率、急性期RP和放射性食管炎发生率相似(P=0.06、0.73、0.13);分层分析仅男性、T₃~T₄期、N₀~N₂期、未化疗者IMRT组生存率低于3DCRT组(P=0.04、0.04、0.02、0.00)。结论 Ⅲ期NSCLC的IMRT与3DCRT疗效相近,但有潜在剂量学优势,其结果有待进一步证实。

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	王玉祥
	田秀明
	邱嵘
	王丽丽
	祝淑钗

关键词 ：肺肿瘤/三维放射疗法, 剂量学, 预后

Abstract：Objective To compare the target dosimetric distribution and clinical outcome in patients with stage Ⅲ non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). Methods The clinical data of 419 patients with stage Ⅲ NSCLC treated with either 3DCRT or IMRT were retrospectively analyzed. Among them, there were 338 male and 81 female patients, and the median age was 63 years (range:32－84 years). There were 340 patients treated with 3DCRT and 79 with IMRT, and the median prescribed dose was 60 Gy (range:50－76 Gy). One hundred and forty patients were treated with radiotherapy alone and 279 were treated with chemoradiotherapy. The target dosimetric distribution was evaluated with dose-volume histogram (DVH) parameters. The overall survival (OS) rate was calculated using the Kaplan-Meier method and analyzed by the log-rank test. Results When comparing the clinical data, the patients treated with 3DCRT were in older ages, and had advanced N and clinical stages (P=0.01, 0.00, and 0.00, respectively). When comparing the target DVH parameters, the patients treated with IMRT had larger planning target volume (PTV)(P=0.01), significantly lower clinical target volume (CTV) D_mean, CTV D₉₀, PTV D_mean, and PTV V₆₅-V60(P=0.05－0.01), significantly higher V₅-V₂₀ in both lungs, higher esophagus D_mean, longer esophagus in the radiation field, higher linear energy transfer between 45 and 55 keV/μm (LET45-LET55), and higher spinal cord D_mean(P=0.03－0.00). The follow-up rate was 97.4%. After radiotherapy, the 1-, 3-, and 5-year OS rates were 65.5%, 26.1%, and 18.5%, respectively, and the median survival time was 20 months. There were no significant differences in OS rate and the incidence of acute radiation pneumonitis and radiation esophagitis between patients treated with IMRT and 3DCRT (P=0.06,0.73,0.13). Stratified analysis showed that, when comparing the patients treated with IMRT with those treated with 3DCRT, the survival rate was only lower in male patients, patients in stage T₃-T₄ or N₀-N₂, and those without chemotherapy (P=0.04,0.04,0.02,0.00). Conclusions The treatment outcomes of patients with stage Ⅲ NSCLC undergoing IMRT and 3DCRT are comparable. IMRT shows a potential dosimetric advantage, but the result needs further investigation.

Key words： Lung neoplasms/three-dimensional radiotherapy Dosimetry Prognosis

收稿日期: 2014-06-12

基金资助:河北省医学科学研究重点课题(ZD20140300)

引用本文:

王玉祥,田秀明,邱嵘等. 3DCRT与IMRT对Ⅲ期NSCLC剂量学及疗效比较[J]. 中华放射肿瘤学杂志, 2015, 24(2): 126-130.

Wang Yuxiang,Tian Xiuming,Qiu Rong et al. Comparison of target dosimetry and treatment outcome in patients with stage Ⅲ non-small cell lung cancer treated with three-dimensional conformal radiotherapy and intensity-modulated radiotherapy[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 126-130.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2015.02.000 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2015/V24/I2/126

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