Department of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, USA.
J Thorac Oncol. 2010 Feb;5(2):185-90. doi: 10.1097/JTO.0b013e3181c6eb20.
Palliative chest radiotherapy (RT) for lung malignancies is effective in relieving serious chest symptoms from tumor bleeding or mass effect on major airways, vessels, and nerves. Albeit an important subject, there is a lack of consensus for an optimal palliative RT regimen. We report the outcomes of a split-course palliative chest RT, a frequently used schema at our institution.
Records of 140 patients treated between 1995 and 2006 were reviewed. Treatment was prescribed to an initial 25 Gy in 10 fractions through anterior-posterior/posterior-anterior beam arrangements. After a 2-week rest period, patients were selected to receive an additional 10 Gy (anterior-posterior/posterior-anterior) followed by off-cord beams to a final dose of 50 to 62.5 Gy. Symptom relief and toxicity during RT and after completion of RT were assessed from clinician notes and patient-reported symptom inventory forms. Second, the impact on survival was assessed.
Symptomatic relief was observed in 52 to 84% of patients with durable palliation in 58%. There were no grade 3 to 5 toxicities. Grades 1 and 2 esophagitis and pneumonitis were observed in 34 and 8% patients, respectively. Median survival was 5 months.
A majority of patients experienced symptomatic improvement. The built-in 2-week break allowed for selection of patients for high-dose palliative radiation and balanced treatment benefits with potential side effects. Cancer survival was not adversely affected by treatments in this population with mostly advanced disease. This regimen is a viable option for patients who cannot tolerate a protracted, uninterrupted course of treatment.
针对肺部恶性肿瘤引起的严重胸部症状，如肿瘤出血或大气道、血管和神经受压，采用姑息性胸部放疗（RT）是有效的。虽然这是一个重要的课题，但对于最佳的姑息性 RT 方案尚未达成共识。我们报告了在我院常用的分割疗程姑息性胸部 RT 的结果。
回顾了 1995 年至 2006 年间治疗的 140 例患者的记录。治疗方案为初始剂量 25 Gy，分 10 次给予，采用前后/后前光束排列。休息 2 周后，根据患者情况选择给予额外的 10 Gy（前后/后前），然后加照楔形野，总剂量达到 50 至 62.5 Gy。从临床医生的记录和患者报告的症状清单中评估 RT 期间和 RT 完成后的症状缓解和毒性。其次，评估其对生存的影响。
52%至 84%的患者出现症状缓解，其中 58%的患者缓解持久。无 3 至 5 级毒性。分别有 34%和 8%的患者出现 1 级和 2 级食管炎和放射性肺炎。中位生存时间为 5 个月。
大多数患者的症状得到改善。内置的 2 周休息期允许选择高剂量姑息性放疗的患者，并平衡治疗益处和潜在的副作用。对于大多数晚期疾病患者，癌症的生存并未受到治疗的不利影响。对于不能耐受长期、不间断治疗的患者，该方案是一种可行的选择。
