摘要目的 分析同期整合推量调强放疗(SIB-IMRT)技术在不可手术局部晚期非小细胞肺癌(NSCLC)中的临床疗效及毒副反应.方法 回顾性分析从2012年2月至2015年7月在本院行SIB-IMRT的不可手术局部晚期NSCLC患者58例的临床资料,处方剂量为PTV 50 ～ 64 Gy/26 ～ 30次,单次剂量为1.8～2.2 Gy;PGTV为60～ 70 Gy/26 ～ 30次,单次剂量为2.0～2.35 Gy.结果 随访时间6～40(中位随访时间28)个月,患者的中位总生存期和无进展生存期分别为25.0(95％ CI:23.8 ～26.2)和15.0(95％ CI:11.3 ～ 18.7)个月;1、2年生存率分别为91.4％和51.7％;1、2年无进展生存期分别为56.9％和22.7％;无患者发生≥4级放射性肺炎和放射性食管炎;在亚组分析中,N3期患者≥2级放射性食管炎发生率(29.2％)高于N0 ～ N2期患者(20.6％),差异有统计学意义(P＜0.05).结论 SIB-IMRT技术治疗不可手术局部晚期NSCLC患者是可行的,毒副反应可以耐受,值得进一步开展大样本量的前瞻性临床试验.

abstractsObjective To investigate the clinical efficacy and toxicity in the use of simultaneous integrated boost intensity modulated radiation therapy (SIB-IMRT) for inoperable locally advanced nonsmall cell lung cancer (LA-NSCLC).Methods Between February 2012 and July 2015,58 pathologically diagnosed inoperable LA-NSCLC patients treated with SIB-IMRT were analyzed.A radiation dose of 50-64 Gy was administered in 1.8-2.2 Gy/fraction (26-30 fractions) to the planning target volume (PTV).Simultaneously,60-70 Gy was administered in 2.0-2.35 Gy/fraction (26-30 fractions) to the planning gross tumor volume (PGTV).Results The median follow-up time was 28.0 months (ranging from 6.0 to 40.0 months).The median overall survival (OS) and progress-free survival (PFS) were 25.0 (95％ CI:23.8-26.2) and 15.0 (95％ CI:11.3-18.7) months,respectively.The 1-,2-year OS were 91.4％ and 51.7％,respectively.The 1-,2-year PFS were 56.9％ and 22.7％,respectively.None of the patients developed grade 4 or 5 pneumonitis and esophagitis.In addition,in the subgroup analysis,the patients with N3 have a higher incident of ≥ grade 2 esophagitis compared with N0-N2,the incident are 29.2％ and 20.6％,respectively (P ＜ 0.05).Conclusions SIB-IMRT is feasible and well-tolerated for inoperable LA-NSCLC patients.It remains to be further evaluated in a large sample size prospective clinical trial.