- 弥漫性胸膜间皮瘤的三维适形调强放疗
- 作者:王凤玮|发布时间:2012-04-07|浏览量:604次
E 弥漫性恶性胸膜间皮瘤三维适形放疗的近期疗效及其与改良的半胸照射放疗技术比较的研究天津市人民医院放疗科王凤玮
通讯作者:王凤玮 天津市红桥区130号 天津市人民医院放疗科 300130
Email: wfengwei2004@tom.com 电话13332082021
【摘要】 目的 弥漫性恶性胸膜间皮瘤治疗以手术和化疗为主,放疗常规采用半胸照射的技术,因肺损伤较大,使得放疗在弥漫性恶性胸膜间皮瘤治疗中的价值不明确。我们采用X射线三维适形放疗(3DCRT)加电子线野灵活布野的模式治疗8例弥漫性恶性胸膜间皮瘤,观察其近期疗效和放射损伤;并模拟改良的常规半胸照射放疗的方法,比较二种技术的肺损伤大小。方法 自2005.1-2007.11我院收治的8例弥漫性恶性胸膜间皮瘤,其中5例为多程化疗失败者,3例为单纯放疗。化疗方案为GP、NP、TP或/和培美曲噻+卡铂,放疗采用X射线三维适形放疗和电子线野灵活布野的治疗模式,按常规分割的方式给予总量32.2-64Gy照射。同时模拟常规半胸照射放疗的技术,采用TPS系统模拟并计算肺的V20、V30和平均肺受量(MLD),与三维适形放疗和电子线野灵活布野的治疗模式相比较。结果 8例病人放疗后1例病人达CR,其余病人均达PR。2例病人死亡,其余6人均存活,病人平均生存时间为15.4个月。采用化疗+放疗者平均生存时间为18.8个月,单纯放疗组为9.7个月。采用三维适形放疗加电子线野灵活布野的治疗模式8例病人的平均V20为20.5%,V30为15.6%,患侧肺MLD为18.8Gy,健侧肺MLD2.2Gy。模拟常规半胸照射放疗技术8例病人的平均V20为36.8%,V30为27.9%,患侧肺MLD为31.1Gy,健侧肺MLD1.2Gy。两种技术之间肺V20、V30和患侧肺MLD存在明显差异(p<0.01),健侧肺MLD无显著差异(p=0.08)。采用三维适形放疗加电子线野灵活布野的治疗模式8例病人均出现放射性纤维化,均为1-2度放射性肺炎。根据治疗前和治疗后生活质量评估显示治疗后的生活质量由治疗前的平均2.83上升为3.76,疗前后有明显差异((p<0.01),生活质量有所改善。结论 弥漫性恶性胸膜间皮瘤对放疗有一定的敏感性,采用三维适形放疗加电子线野灵活布野的治疗模式是可行的,较改良的常规半胸照射放疗方式为佳,与相关文献相比较生存期无下降,但肺损伤明显减少,病人的生活质量有较明显的改善。
【关键词】弥漫性恶性胸膜间皮瘤,3DCRT,放射损伤,放射性肺炎
Results of dynamic 3D-conformal radiotherapy treatment of patients with Diffuse Malignant Pleural Mesothelioma and comparative study of dynamic 3D-conformal radiotherapy and conventional radiotherapy technique
WANG Feng-wei, ZHU Si-wei, WANG Xin-zhuo, CAI Yu-mei, ZHANG Chao, YAO Qiang, QING Yu-kun, JIA Pei-jie, LI Wei-lian
Department of Radiation Oncology, Tianjin People’s Hospital, Tianjin 300130, P. R. China
[ABSTRACT] OBJECTIVE: Patients with Diffuse Malignant Pleural Mesothelioma (MPM) are mainly treated with surgery. Modified hemithoracic conventional radiotherapy (CRT) was mostly used for postoperative for its severe radiation pneumonitis leading to the uncertainties of radiation in MPM treatment. New technique of dynamic 3D-conformal radiotherapy (3DCRT) with combination of photon and electron is used in our study to its short-term outcome and it is compared with the CRT treatment plans to explore the possibility of radiation pneumonitis. METHODS: From Jan. 2005 to Oct. 2007, 8 patients with MMP were treated with 3DCRT. 5 patients had received cycles of chemotherapy and 2 were treated with 3DCRT alone. New technique of dynamic 3D-conformal radiotherapy( 3DCRT) with combination of photon and electron is used in our study,and DT 32.2-64Gy with conventional split were delivered. CRT technique was mimicked to compare with 3DCRT technique to explore the possibility of lung damage in two methods. RESULTS One patient reached CR and other 7 patients got PR after irradiation. Two patients died during the follow-up. The media survival time (MST) is 15.4m and it was 18.8m for sequential chemotherapy and radiotherapy group and 9.7m for radiotherapy alone. The V20, V30, ipsi-lateral MSD and contra-lateral MSD was 20.5%, 15.6%, 18.8Gy and 2.2Gy respectively when the dynamic 3DCRT technique was used, whereas it was 36.8%, 27.9%, 31.1Gy and 1.2Gy respectively when the CRT technique was used. It was statistically different for the lung V20, V30 and ipsi-lateral MLD between the two techniques ( p<0.01 ), whereas the contra-lateral MLD was not between the two techniques ( p=0.08 ). All patients received radiation was found to have lung fibrosis and were classified as stage 1-2 radiation pneumonitis. The quality of life was increased from score 2.83 to 3.76 and it was apparently different between them (p<0.01 ). CONCLUSION MPM is moderately sensitive to irradiation and the dynamic 3DCRT technique is feasible in the treatment of MPM and lung damage is reduced apparently comparing with the CRT technique. The quality of life of patients with MPM is improved after irradiation.
【key words】Diffuse malignant pleural mesothelioma, 3DERT, radiation damage, radiation pneumonitis