恶性肿瘤再程放疗疗效观察.docVIP

恶性肿瘤再程放疗疗效观察 　　摘要：目的 观察恶性肿瘤再程放疗的疗效。方法 回顾性分析29例接受再程放疗的患者，其中食管癌15例，鼻咽癌5例，椎体转移癌3例，宫颈癌、直肠癌、鼻腔NK/T细胞淋巴瘤、脑转移癌、髓母细胞瘤和脑胶质瘤各1例，肿瘤靶区剂量30～50Gy/10～25f。结果 对存在可评价病灶者，在放疗结束后取得完全缓解（CR）者为38.5%（10例/26例），部分缓解（PR）为46.2%(12例/26例)， 1例（3.8%）稳定（SD），2例（7.7%）PD，1人未评估。无进展生存期为4～36个月，中位时间8个月，1年的无进展生存率（PFS）为65%。严重的急性和晚期放射反应发生率分别为6.9%。结论 再程放疗安全、有效。 　　关键词：恶性肿瘤；再程放疗 　　中图分类号:R246.5 文献标识码:B 　　 　　Effectiveness of Re-irradiation for Patients with M alignant Tumor 　　SONG Geng，HONG Yan-yan，CHEN Huai-dong，LI Chao，CHEN Zhen-dong 　　(Department of Oncology, The Second Affiliated Hospital of Anhui Medical University，Hefei 230601,Anhui,China) 　　Abstract：ObjectiveTo observe the effectiveness of re-irradiation for m alignant tumor.Methods29 paitents with m alignant tumor re-irradiated were enrolled,in whom 15 patients with esophageal cancer,5 with nasopharyngeal cancer,3 with spinal bone metastases,one with rectal cancer,one with cervical cancer,one with NK/T lymphoma in nasal cavity,one with metastatic brain tumor,one with medulloblastoma and one with cerebral glioma.The total dose of GTV was 30～50Gy with 2～3Gy per fraction.ResultsFor the 26 evaluable patients,complete response was 38.5%,partial response was 46.2%,stable disease was 3.8% and progress disease was 7.7%.One patient did not receive the evaluation.The median time to progression was 8 months(range:4～36 months),and the 1-year progression free survival was 65%.The severe acute and late adverse events occurred in 6.9% of patients,respectively. ConclusionRe-irradiation was effective and showed acceptable toxicity. 　　Key words：M alignant tumor；Re-irradiation 　　放疗在恶性肿瘤的治疗中占重要地位，对部分鼻咽癌、食管癌和宫颈癌可起根治效果，但其治疗失败原因仍以照射野内复发为主，约20%～40%[1]，此外接受姑息性放疗者也会因局部病情进展引起的症状而影响患者生活质量，这部分患者仍可能通过局部治疗，如再程放疗而获益。现对我科29例接受再程放疗患者进行回顾性分析。 　　1资料与方法 　　1.1一般资料2010年10月~2013年11月，我科共29例患者在首程放疗靶区内出现新发病灶或原有椎体转移病灶导致的脊髓压迫症状加重，除3例颅内病灶、3例椎体病灶及1例盆腔淋巴结病灶外，余皆经活检病理证实为复发并接受再程放疗。患者年龄25～89岁，中位年龄64岁；KPS 60～90分，中位80分；原发肿瘤包括食管癌、鼻咽癌、宫颈癌、前列腺癌、直肠癌、卵巢癌、NK/T细胞淋巴瘤、髓母细胞瘤和脑胶质瘤；患者首程都接受足量放疗：鼻咽癌70Gy/35f，食