Clinical and histopathological research on radiation therapy for early stage non-small cell lung cancer

1)前瞻性评价高剂量率（HDR）支气管内近距离放射治疗x线阴性支气管癌的疗效。我科对12例患者（男11例，女1例）14个病灶行外置放疗联合HDR支气管内近距离放疗。放射剂量为40 Gy，分20次进行体外放疗。支气管内近距离放射治疗为10-25 Gy，剂量参考点根据支气管直径，分别距施药器中心5-10 mm半径。所有患者肉眼完全缓解。虽然随访时间从6到33个月不等，中位为11个月，但没有患者出现局部进展。未观察到放射性肺炎或其他治疗相关并发症。以上结果提示，对于局限于支气管壁的x线造影阴性肿瘤，无邻近实质延伸或转移性疾病的患者，可采用外置放疗和近距离HDR联合治疗。2)分析不能手术的外周I期非小细胞肺癌（NSCLC）患者有限野照射的效果，探讨选择性局部淋巴结照射。10例选择性局部放疗患者与26例未行局部淋巴结放疗患者的疾病特异性生存率无显著差异。只有1例没有局部淋巴结照射的患者发生了孤立的局部失败。对于医学上不能手术的外周I期非小细胞肺癌患者，高剂量限定野放疗是合理的。由于局部复发率低，这些肺损害患者可省略局部淋巴结照射。3)应用免疫组织化学方法探讨核p53蛋白表达对36例不能手术或不能切除的非小细胞肺癌放疗（RT）患者生存及局部控制的预后意义。所有p53阴性病例对放疗有应答，而p53阳性病例对放疗有应答的占72% （P<0.05）。p53阴性患者的2年生存率优于p53阳性患者，但差异无统计学意义。提示p53蛋白表达可能对非小细胞肺癌RT治疗应答具有预测价值。4)我们设计了本前瞻性研究，以评估FDG PET在原发性肺癌确诊放射治疗（RT）患者中检测复发或残留肿瘤的价值。采用标准化摄取值（SUV）【大于或等于】3检测复发病变，敏感性为75%，特异性为100%，准确性为89%。PET可用于区分复发性病变和放疗后病变。少

1) The effectiveness of high dose rate (HDR) endobronchial brachytherapy for roentgenographically negative carcinoma of the bronchus was prospectively evaluated. In our department, 14 lesions in 12 patients (11 male, one female) were treated with a combination of external radiotherapy and HDR endobronchial brachytherapy. Radiation dose was 40 Gy in 20 fractions for external radiotherapy. Endobronchial brachytherapy consisted of 10-25 Gy with 5 Gy/fr and the dose reference point varied 5-10 mm radius from the center of the applicator each according to a diameter of the bronchus. All patients had macroscopic complete response. Although the follow-up period ranged from 6 to 33 months with a median of 11 months, there were no patients with local progression. Radiation pneumonitis or other treatment-related complications have not been observed. These results suggested that the combination treatment of external radiotherapy and HDR brachytherapy can be used as curative intent for selected pa … More tients who have roentgenographically negative tumors limited to the bronchial wall without adjacent parenchymal extension or metastatic disease.2) The outcome of limited field irradiation for medically inoperable patients with peripheral stage I non-small cell lung cancer (NSCLC) was analyzed to discuss the elective irradiation of regional lymph nodes. There was no significant difference in disease-specific survival between ten patients with the elective regional irradiation and 26 patients without the regional nodal irradiation. Only one patient without regional nodal irradiation developed an isolated regional failure. High-dose limited field RT is justified for medically inoperable patients with peripheral stage I NSCLC. The regional nodal irradiation can be omitted in these pulmonary compromised patients because of the low regional relapse rate.3) The prognostic significance of nuclear p53 protein expression in survival and local control was investigated immunohistochemically in 36 patients with inoperable or unresectable non-small cell lung cancer who were treated with radiation therapy (RT). Response to RT was found in all p53 negative cases versus 72% in p53 positive cases (P<0.05). The 2-year survival rate for p53 negative cases was superior to that for p53 positive cases, although this difference was not statistically significant. The results suggested that p53 protein expression may be of predictive value on response to RT in non-small cell lung cancer.4) We designed the current prospective study to evaluate FDG PET in the detection of recurrent or residual tumors in patients who had undergone definitive radiation therapy (RT) for primary lung cancer. With a standardized uptake value (SUV) 【greater than or equal】 3 used for detecting recurrent lesion, sensitivity, specificity, and accuracy were 75%, 100%, and 89%, respectively. PET may be useful for distinguishing recurrent lesion from postradiation changes. Less