三维适形放疗与调强放疗对晚期非小细胞肺癌患者血清肿瘤标志物及剂量学参数比较研究

目的:对比晚期非小细胞肺癌患者经三维适形放疗(3D-CRT)与调强放疗(IMRT)后,其血清肿瘤标志物及剂量学参数的变化。方法:选择2015年1月-2016年12月期间我院收治的非小细胞肺癌患者120例,根据放疗方案将其分为IMRT组60例与3D-CRT组60例。比较两组临床疗效、药物毒副反应、1年内的生存率、放射剂量参数,以及治疗前与治疗后血清肿瘤标志物的变化。结果:IMRT组治疗的总有效率与3D-CRT组对比差异无统计学意义(P0.05)。IMRT组血小板减少、Ⅲ度放射性食管炎、Ⅲ度消化道反应、Ⅲ度放射性肺炎、Ⅲ度白细胞减少的发生率均低于3D-CRT组(P0.05)。IMRT组1年内的生存率90.00%,高于3D-CRT组的75.00%(P0.05)。IMRT组CI值与HI值均高于3D-CRT组(P0.05),IMRT组与3D-CRT组平均剂量对比差异无统计学意义(P0.05)。治疗后两组鳞状细胞癌抗原(SCC)、细胞角蛋白19片段抗原21-1(CYFRA21-1)与肿瘤特异性生长因子(TSGF)水平均显著降低,且IMRT组低于3D-CRT组(P0.05)。结论:IMRT与3D-CRT对于晚期非小细胞肺癌患者的临床疗效相当,但IMRT药物毒副反应少、放射剂量低,可能通过控制肿瘤来降低肿瘤标志物水平。

Comparison of Serum Tumor Markers and Dosimetric Parameters between Three Dimensional-conformal Radiotherapy and Intensity Modulated Radiation Therapy in Patients with Advanced Non-small Cell Lung Cancer

ABSTRACT Objective: To compare the changes of serum tumor markers and dosimetry parameters after three dimensional-confor- mal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in patients with advanced non-small cell lung cancer. Methods: 120 cases of non-small cell lung cancer who were treated in our hospital from January 2015 to December 2016 were selected,the patients were divided into IMRT group with 60 cases and 3D-CRT group with 60 cases according to the radiotherapy plan. The clini- cal efficacy, drug side effects, 1 year survival rates, radiation dose parameters and changes in serum tumor markers before and after treat- ment of the two groups were compared. Results: There was no significant difference in the total effective rate between IMRT group and 3D-CRT group (P>0.05). The incidence of thrombocytopenia, > III degree radiation-induced esophagitis, > III degree digestive tract reac- tion, > III degree radionuclide pneumonia, > III degree leukocyte reduction in the IMRT group were lower than that of the 3D-CRT group (P<0.05). The 1 year survival rate in IMRT group was 90.00%, which was higher than 75.00% in 3D-CRT group (P<0.05). The CI value and HI value of IMRT group were higher than those of 3D-CRT group(P<0.05), there was no significant difference in average dose be- tween group IMRT and 3D-CRT group(P>0.05). After treatment, the levels of two groups of squamous cell carcinoma antigen (SCC), cy- tokeratin 19 fragment antigen 21-1(CYFRA21-1) and tumor specific growth factor (TSGF) were significantly decreased,and the IMRT group was lower than the those of 3D-CRT group(P<0.05). Conclusion: The clinical effect of IMRT and 3D-CRT on patients with ad- vanced non-small cell lung cancer is similar, but the side effects of IMRT drugs are less and the dose of radiation is low. It may reduce the level of tumor markers by controlling the tumor.