本文選題：小細(xì)胞肺癌 + 放射治療��； 參考：《天津醫(yī)科大學(xué)》2015年博士論文

【摘要】：研究目的:同步放化療是局限期小細(xì)胞肺癌的標(biāo)準(zhǔn)治療手段,但許多病人由于身體原因或病灶范過大等原因沒能直接接受同步放化療,同步放化療的放療最佳劑量及靶區(qū)等都還存在爭論,部分由于各種原因接受手術(shù)治療的病人術(shù)后是否也還要接受放化療,此類病人的放療原則與未做手術(shù)者是否有區(qū)別等等也有待于進(jìn)一步研究。本研究的目的主要有以下兩個方面:1)小細(xì)胞肺癌的個體化放療研究,探討誘導(dǎo)化療后療效是否對放療時機(jī)產(chǎn)生影響、鎖骨上淋巴引流區(qū)預(yù)防照射的適應(yīng)癥及靶區(qū)勾畫、術(shù)后病人胸部放療及腦預(yù)防照射的指征等;2)小細(xì)胞肺癌病人放療技術(shù)的優(yōu)化:胸部放療時降低預(yù)防照射區(qū)照射劑量的可行性研究。研究內(nèi)容與方法:研究內(nèi)容和方法分為以下兩大部分:1)非手術(shù)病人的病歷資料分析:回顧性分析我院接受根治性放射治療的局限期小細(xì)胞肺癌患者臨床病歷資料,根據(jù)2-3周期后誘導(dǎo)化療后療效分為有效組和無效組,根據(jù)2-3個周期后即開始放療還是4個周期以后開始放療分為早放療組和晚放療組,分析誘導(dǎo)化療不同療效及不同放療時機(jī)總生存期及無進(jìn)展生存期的不同;將接受三維適形放療病人的計(jì)劃重新導(dǎo)入計(jì)劃系統(tǒng),在定位CT圖像上分析鎖骨上淋巴結(jié)轉(zhuǎn)移的規(guī)律及風(fēng)險因素;分析我院接受降低預(yù)防照射區(qū)域劑量(大體腫瘤靶區(qū)劑量60Gy/30次,總計(jì)劃靶區(qū)54Gy/30次,SIR-IMRT)與常規(guī)放射治療(總計(jì)劃靶區(qū)60Gy/30次,C-IMRT)病人資料,分析比較兩組病人的局部復(fù)發(fā)率、總生存率及治療相關(guān)毒副作用的差異。2)手術(shù)病人的病歷資料分析:分析我院因各種原因接受手術(shù)治療的小細(xì)胞肺癌病例資料,分析比較不同分期及治療情況下有無術(shù)后放療的生存期差異;分析術(shù)后有腦轉(zhuǎn)移隨訪資料的患者,比較疾病分期、術(shù)前術(shù)后輔助治療等因素對腦轉(zhuǎn)移發(fā)生率的影響研究結(jié)果:1)誘導(dǎo)化療后療效對放療時機(jī)的影響:早放療組和晚放療組的中位OS分別為37.8個月和24.9個月(P=0.052),中位PFS分別為19.4個月和13.8個月(P=0.003)。亞組分析發(fā)現(xiàn),2-3周期誘導(dǎo)化療后有效的患者,早放療組和晚放療組的中位OS分別為40.7個月和24.9個月(P=0.009),PFS分別為23.3個月和13.3個月(P=0.001);誘導(dǎo)化療后無效的患者的中位OS分別為20.8個月和19.7個月(P=0.484),中位PFS分別為11.1個月和14.3個月(P=0.949)。2)鎖骨上淋巴引流區(qū)轉(zhuǎn)移的風(fēng)險因素及轉(zhuǎn)移模式:118例上縱隔陽性病人中有77例(65.3%)發(fā)現(xiàn)鎖骨上淋巴結(jié)轉(zhuǎn)移,而121例上縱隔陰性病人中只有6例(5.0%)發(fā)現(xiàn)鎖骨上淋巴結(jié)轉(zhuǎn)移(P=0.000)。95.2%的鎖骨上淋巴結(jié)轉(zhuǎn)移累及喉返神經(jīng)旁淋巴結(jié)下區(qū)(Ⅰ區(qū))與頸內(nèi)靜脈旁淋巴結(jié)區(qū)(Ⅲ區(qū)),I、III區(qū)陰性而出現(xiàn)其他區(qū)域轉(zhuǎn)移的病例只有4.8%。3)小細(xì)胞肺癌術(shù)后的胸部放療和腦預(yù)防照射:對于有肺門及縱隔淋巴結(jié)轉(zhuǎn)移病人,術(shù)后胸部放療與未放療的中位生存期分別為66.7月和34.6月(p=0.016),術(shù)后病理分期N0患者行胸部放療者和未行放療者的中位生存期分別為37.3月和96.8月(P=0.561)。全組病人3年腦轉(zhuǎn)移發(fā)生率20.6%。術(shù)后I、II、III期患者3年腦轉(zhuǎn)移發(fā)生率分別為6.3%、28.2%、29.0%(P=0.026)。多因素回歸分析顯示術(shù)后病理分期(P=0.002)及手術(shù)切除情況(P=0.020)是影響腦轉(zhuǎn)移的獨(dú)立預(yù)后因素。4)小細(xì)胞肺癌降低預(yù)防照射區(qū)劑量的研究:有137例病人符合入組條件,72例病人接受了SIR-IMRT,65例病人接受了C-IMRT,經(jīng)傾向評分配對分析后兩組各有42例病人進(jìn)入分析。兩組的3年生存率分別為51.0%和45.0%(P=0.066),3年無局部區(qū)域復(fù)發(fā)生存率分別為71.2%和39.2%(P=0.119)。兩組病人3級以上放射性肺損傷發(fā)生率分別為4.8%和11.9%。3級以上食管損傷發(fā)生率亦分別為4.8%和11.9%。結(jié)論:局限期小細(xì)胞肺癌2-3周期誘導(dǎo)化療后應(yīng)該盡快開始放療,尤其是對于化療后有效的病人;對于有上縱膈淋巴結(jié)轉(zhuǎn)移的病人,需要行鎖骨上區(qū)預(yù)防性照射;小細(xì)胞肺癌術(shù)后病人如果有淋巴結(jié)轉(zhuǎn)移,應(yīng)該接受胸部放療,同時接受腦預(yù)防照射;小細(xì)胞肺癌降低預(yù)防區(qū)照射劑量可以降低毒副作用,而不會影響放療療效。
[Abstract]:Objective: synchronous radiotherapy is the standard treatment for small cell lung cancer in limited period, but many patients have not been able to receive synchronous radiotherapy directly due to physical causes or large lesions, and the optimal dose and target area of radiotherapy in synchronous radiotherapy and chemotherapy are still controversial. The purpose of this study is two aspects: 1) the study of individualized radiotherapy for small cell lung cancer, whether the effect of induced chemotherapy on the timing of radiotherapy, and the prefusion of supraclavicular lymphatic drainage area Indications of anti irradiation and target area mapping, the indication of chest radiotherapy and cerebral prophylaxis for postoperative patients, etc.; 2) optimization of radiotherapy technology in small cell lung cancer patients: feasibility study on reducing radiation dose in radiation prevention area during chest radiotherapy. Research contents and methods are divided into two parts: 1) the medical records of non operative patients. Data analysis: retrospective analysis of clinical records of patients with localized small cell lung cancer in our hospital after radical radiation therapy. According to the 2-3 cycle after induction chemotherapy, the curative effect was divided into effective and ineffective groups. According to the 2-3 cycles after the radiotherapy or after 4 cycles, the radiotherapy group and the late radiotherapy group were divided into early radiotherapy group and late radiotherapy group, and the inducement was analyzed. The difference in the total survival and the progression free survival period of different therapeutic effects and different radiotherapy opportunities; the plan system was re introduced for the patients receiving three-dimensional conformal radiotherapy to analyze the regularity and risk factors of the supraclavicular lymph node metastasis in the positioning CT image. 30 times, the total plan target area 54Gy/30, SIR-IMRT) and conventional radiotherapy (total plan target area 60Gy/30 times, C-IMRT) patient data, analysis and comparison of the local recurrence rate, total survival rate and the difference of the side effects of treatment related to the treatment of the two groups of patients.2) the analysis of the medical records of the patients in the operation: analysis of the small cell lung of our hospital for various reasons for various reasons. Cancer case data, analysis and comparison of different stages and treatment with or without postoperative radiotherapy difference of survival; analysis of postoperative follow-up data of patients with brain metastases, comparison of disease staging, preoperative and postoperative adjuvant therapy and other factors on the incidence of brain metastasis: 1) the effect of chemotherapy after chemotherapy on the timing of radiotherapy: early radiotherapy group and The median OS of the late radiotherapy group was 37.8 months and 24.9 months (P=0.052), and the median PFS was 19.4 months and 13.8 months respectively (P=0.003). The subgroup analysis found that the middle OS of the early radiotherapy group and the late radiotherapy group was 40.7 months and 24.9 months respectively (P=0.009), and the PFS was 23.3 and 13.3 months respectively (P=0.001). The median OS of ineffective patients after induction chemotherapy was 20.8 months and 19.7 months (P=0.484), the median PFS was 11.1 months and 14.3 months (P=0.949).2), the risk factors for the metastasis of the supraclavicular lymphatic drainage area and the transfer mode: 77 of the 118 upper mediastinal positive patients (65.3%) found the supraclavicular lymph node metastasis, while 121 were negative in the mediastinum. Only 6 cases (5%) found the supraclavicular lymph node metastases (P=0.000).95.2%'s supraclavicular lymph node metastasis involving the subregion of the paravicular lymph node (area I) and the adjacent lymph nodes of the internal jugular vein (zone III). The cases of I, III negative and other regional metastasis were only 4.8%.3) the chest radiotherapy and cerebral prophylactic irradiation after the operation of small cell lung cancer: For patients with pulmonary and mediastinal lymph node metastases, the median survival period of postoperative chest radiotherapy and non radiotherapy was 66.7 months and 34.6 months respectively (p=0.016). The median survival period of the postoperative pathological staging N0 patients with chest radiotherapy and non radiotherapy were 37.3 months and 96.8 months respectively (P=0.561). The 3 year incidence of brain metastases in the whole group was I, II, II after the operation of 20.6%.. The incidence of brain metastases in 3 years of I patients was 6.3%, 28.2%, and 29% (P=0.026). Multivariate regression analysis showed that postoperative pathological staging (P=0.002) and surgical excision (P=0.020) were independent prognostic factors of brain metastases.4) small cell lung cancer decreased the dose of prophylactic irradiation area: 137 patients met the conditions of entry, 72 patients accepted SIR-IMRT, 65 patients received C-IMRT, and 42 patients in each of the two groups entered the analysis after the tendency score matching analysis. The 3 year survival rates of the two groups were 51% and 45% (P=0.066), and the local regional recurrent survival rates were 71.2% and 39.2% (P=0.119), respectively. The incidence of upper radioactive lung injury in the two group was respectively 4.8% and 11.9%.3, respectively. The incidence of the above esophageal injury is also 4.8% and 11.9%., respectively: the 2-3 cycles of localized small cell lung cancer should be treated as soon as possible after chemotherapy, especially for patients who are effective after chemotherapy; for patients with upper mediastinal lymph node metastases, prophylactic irradiation is required; patients with small cell lung cancer have lymph nodes if they have lymph nodes. Metastasis should be treated with chest radiotherapy and cerebral prophylaxis. Small cell lung cancer reduces the dose of the prevention area to reduce toxic and side effects without affecting the effect of radiotherapy.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R734.2

【共引文獻(xiàn)】

相關(guān)期刊論文 前4條

1 張赫男;劉云鵬;;局限期小細(xì)胞肺癌治療的研究進(jìn)展[J];中南大學(xué)學(xué)報(醫(yī)學(xué)版);2013年08期

2 侯俊;馮林春;馬林;曲寶林;彭亮;王運(yùn)來;許衛(wèi)東;權(quán)建華;張富利;王雅棣;;乳腺癌腦轉(zhuǎn)移47例三維適形放療療效及預(yù)后分析[J];解放軍醫(yī)學(xué)院學(xué)報;2014年10期

3 徐秀理;陸林;胡宗濤;高世樂;費(fèi)振樂;;小細(xì)胞肺癌同期化放療的臨床結(jié)果分析[J];臨床肺科雜志;2015年06期

4 趙智宏;王勝發(fā);姜久仰;高大登;王巨;常浩;曲俊峰;;Pokemon在小細(xì)胞肺癌中的表達(dá)及臨床意義[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2014年36期

相關(guān)博士學(xué)位論文 前1條

1 張文玨;小細(xì)胞肺癌的綜合治療及預(yù)后因素研究[D];北京協(xié)和醫(yī)學(xué)院;2015年

相關(guān)碩士學(xué)位論文 前5條

1 孔錦;76例小細(xì)胞肺癌綜合治療的臨床研究與預(yù)后因素分析[D];大連醫(yī)科大學(xué);2012年

2 張睿;局限期小細(xì)胞肺癌不同劑量腦預(yù)防照射的臨床觀察[D];大連醫(yī)科大學(xué);2013年

3 高玉杰;卡莫司汀及全腦預(yù)防照射對緩解期小細(xì)胞肺癌腦轉(zhuǎn)移預(yù)防作用的療效觀察及預(yù)后相關(guān)性分析[D];大連醫(yī)科大學(xué);2013年

4 亞瑟（YASIR AHMED MOHAMMED KHAIR）;[D];華中科技大學(xué);2013年

5 龔海燕;265例小細(xì)胞肺癌療效和預(yù)后相關(guān)因素分析[D];大連醫(yī)科大學(xué);2014年

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