Wu K, Jiang G, Liao Y, Wang L, Qian H, Yang H, Zhang Z, Hu C, Zhao S
Department of Radiation Oncology,Cancer Hospital,Medical Center,Fudan University (Former Shanghai Medical University),Shanghai 200032,P.R.China.
Zhongguo Fei Ai Za Zhi. 2000 Oct 20;3(5):322-5. doi: 10.3779/j.issn.1009-3419.2000.05.02.
To establish the technique of 3-dimensional conformal radiation therapy (3DCRT) for non-small cell lung cancer (NSCLC) in stage II-IIIB,and to assess its acute side-effects and to obtain the maximum tolerance dose (MTD).
From June,1999 to June,2000,38 cases of NSCLC in stage II-IIIB were enrolled in this study.MTD was identified by dose escalation study.After 42Gy/21Fx/4.2wks by conventional fractionated irradiation through AP/PA fields,which covered the primary tumor and lymph nodes,the technique of 3DCRT was used as boost.The boost fields encompassed the clinical lesions showed on chest CT.The planning of total dose escalation depended on the percentage,i.e.,<25%,25%-37%,and >37% of normal lung volume irradiated to over 20Gy.The scheduled dose escalation ranged from 69 to 81Gy.The criteria for stopping dose escalation was grade III or more worse radiation pneumonitis (RTOG).The boost doses were delivered with 3Gy/fraction,once a day,5 fractions a week.
Thirty-three cases had completed their treatments and could be evaluated by now.Acute radiation pneumonitis occurred in 26% of patients with grade I-II and 3% with grade III,and acute radiation esophagitis in 61% with grade I-II and 9% with grade III,and the hematopoietic toxicity in 58% with grade I-II and 9% with grade III.The current doses implemented were 78,78,and 75Gy respectively for patients with <25%,25%-37%,and >37% of normal lung volume irradiated.The overall immediate response rate of tumors was 88%(29/33).
Dose escalation in a volume-dependent organ as the lungs is acceptable and applicable.The immediate response is encouraging.MTD is to be determined.The long-term follow-up is needed to observe late complications and treatment efficacy.
建立适用于II - IIIB期非小细胞肺癌（NSCLC）的三维适形放射治疗（3DCRT）技术，评估其急性副作用并获得最大耐受剂量（MTD）。
1999年6月至2000年6月，38例II - IIIB期NSCLC患者纳入本研究。通过剂量递增研究确定MTD。经前后野常规分割照射42Gy/21次/4.2周，覆盖原发肿瘤和淋巴结后，采用3DCRT技术进行追加剂量照射。追加剂量照射野包括胸部CT显示的临床病灶。总剂量递增计划取决于正常肺组织受照超过20Gy的体积百分比，即<25%、25% - 37%和>37%。预定的剂量递增范围为69至81Gy。停止剂量递增的标准是出现III级或更严重的放射性肺炎（RTOG标准）。追加剂量以3Gy/次，每日1次，每周5次的方式给予。
33例患者已完成治疗并可进行评估。急性放射性肺炎发生率为26%（I - II级）和3%（III级），急性放射性食管炎发生率为61%（I - II级）和9%（III级），血液学毒性发生率为58%（I - II级）和9%（III级）。正常肺组织受照体积<25%、25% - 37%和>37%的患者目前实施的剂量分别为78Gy、78Gy和75Gy。肿瘤的总体近期缓解率为88%（29/33）。
在像肺这样的与体积相关的器官中进行剂量递增是可行且适用的。近期缓解情况令人鼓舞。MTD有待确定。需要长期随访以观察晚期并发症和治疗效果。
