摘要
目的比较非小细胞肺癌（NSCLC）大剂量常规分次（HF）三维适形放疗（3DCRT）和常规分割（CF）3DCRT对心脏的影响，寻找预测放射性心肌纤维化的有效指标。方法将60例Ⅰ～Ⅲ期NSCLC患者随机分组：HF组30例，4Gy／次，72Gy／18次，5次7周，24d完成3DCRT；CF组30例，2Gy／次，72Gy／36次，5次／周，50d完成3DCRT。放疗前、放疗40Gy、放疗结束时和放疗结束后1个月测定患者肌钙蛋白I（cTnI）血清浓度，患者放疗结束时行24h动态心电图（24h-AECG）监测，1年后复查心脏单光子发射体层摄影（SPECT）及彩色多普勒超声心动图（CDE），胸部CT评价放射性心包损伤的发生。结果60例均完成放疗计划，随访12个月。放疗40Gy及放疗结束时，HF组删血清浓度高于CF组（P〈0．05）。两组放射性心包损伤的发生、心电图、心脏SPECT及彩色超声心动图检查结果比较，差异无统计学意义；放疗40Gy时cTnI血清浓度、V30（接受照射剂量30Gy以上心脏体积占心脏总体积的百分比）及心脏1／3等效体积剂量（D1/3）是放射性心肌纤维化相关因素。结论短期内HF3DCRT未加重放射性心脏损伤，其远期效应需继续观察。cTnI联合剂量体积直方图（DVH）可提高预测放射性心肌纤维化的特异性和敏感性。
Objective To compare side-effect of high-dose conventional fractionation （HF） and conventional fractionation （CF） in three-dimensional conformal radiotherapy （3DCRT） on the heart for non-small-cell lung cancer （NSCLC）, and to explore an effective prediction on radiation-induced myocardial hearts. Methods From April 2004 to January 2007, a total of 60 patients with stage Ⅰ- Ⅲ NSCLC were randomized into the HF group and the CF group, with 30 patients in HF group treated by 4 Gy/f, 72 Gy/18 f/24 d and 30 patients in the CF group by 2 Gy/f, 72 Gy/36 f/50 d. Troponin I （cTnI） in blood was determined before radiotherapy, at a dose of 40 Gy, at the end of radiotherapy and one month after radiotherapy. A 24-hour ambulatory electrocar- diography （24 h-AECG） was performed at the end of radiotherapy. The radiation-induced pericardium injury was evaluated by CT. One year later, patients were subjected to myocardial single photon emission computerized tomography （SPECT） and the color Doppler echocardiography（CDE） test. Results All 60 patients completed radiation treatments. During a follow- up of 12 months, the serum cTnI level in the HF group was significantly higher than in the CF group at a dosage of 40Gy and at the end of-radiotherapy. Differences in results of 24 h-AECG, SPECT and CDE and incidence of radiation pericardium injury between the two groups were not statistically significant. The serum cTnI level at a dosage of 40 Gy, V30, and isoeffective dose for 1/3 isoeffective volume（D1/3 ） were independent risk factors for radiation-induced myocardial fibrosis. Conclusion During the one-year observation, HF had no increased incidence of radiation-induced heart complications, but its long-term effect is unknown. DVH combined with cTnI serum concentration could improve the sensitivity and specificity for identification of radiation-induced myocardial fibrosis.
出处
《山东大学学报（医学版）》
CAS
北大核心
2008年第12期1173-1176,1180,共5页
Journal of Shandong University:Health Sciences
基金
山东省自然科学基金资助课题(Z2005Co2)
关键词
癌
非小细胞肺
放射剂量分次
放射疗法
适形
心脏损伤
Carcinoma, non-small-cell lung
Dose fractionation
Radiotherapy, conformal
Heart injuries
