【摘要】 目的研究６０Ｃｏ和电子线匹配作全胸膜放射治疗胸膜转移伴恶性胸水。方法２５例恶性胸水患者接受治疗。其中肺癌伴恶性胸水２０例，乳腺癌术后胸膜转移伴胸水３例，恶性胸腺瘤术后胸膜转移伴胸水２例。６０Ｃｏ野包括全肺，中央铅块屏蔽，屏蔽处照射电子束，计算中平面胸膜受量，１００％等剂量线为２Ｇｙ，常规照射１５次。可见肿瘤局部加量２０Ｇｙ／１０ＦＸ。中平面约２／３肺组织受量＜５０％。同时接受３～６个疗程化疗。结果２５例恶性胸水完全控制１７例，部分控制７例，总有效率９６％。２２例可见肿瘤３例完全消退，１７例部分消退。经随访，１例无瘤生存１４个月，２例１２个月，１６例４～１１个月。６例死亡，中位生存期９个月。胸水复发４例，总控制率为８０．０％。照射后患者血象较前下降，急性放射性食管炎（Ⅰ～Ⅱ级）１１例，２例胸膜明显增厚伴纤维化。结论６０Ｃｏ和电子线混合照射全胸膜临床上安全且具有较好的疗效更多还原

【Abstract】 URPOSE To study the effect and complications of using combined 60~Co and electron beams to treat pleural malignancy with effusion.METHODS From January 1996 to May 1997,25 patients including 20 primary lung cancers with malignant pleural effusion,3 breast cancers and 2 thymic tumors after operation with malignant pleural effusion received whole pleural irradiation using combined 60Co and electron beams,with different blockages.The pleural effusion was completely drained,and dose distribution at middle level was calculated by TPS using Multidata Co.(USA) EXT 24 version software.The 100% isodose curve was 2 Gy,15 fractions were given and another 20Gy/10Fx irradiation was added to the visible tumor.The TPS isodose curve image,indicates that more than 2/3 lung tissue dose received less than 50%.All patients received sequential chemotherapy for 36 cycles.RESULTS Complete remission of the malignant pleural effusion was seen in 17 of the 25 patients and partial ramission in 7 with 96% over all response rate.An objective response was seen in 20 of 22 visible tumor cases,3 of which had complete response.Followup to August 1997 showed that, 1 patient had already 14 months of disease free survival,2 patients for 12 months,and 16 cases survived from 411 months.Six patients died with survivals of 4,6,8,10,10,12 months,respectively.The median survival time was 9 months.The pleural effusion has been controlled in 20 cases with 800% over all control rate (20/25).We did not find any abnormal in liver function nor in the kidney before and after treatment.The EKG did not show any changes.Myelosuppression was the main side effect after combined chemotherapy and radiotherapy.Eleven cases suffered from acute grade 12 oesophagitis,and 2 cases serious pleural fibrosis.There was no acute irradiation pneumonitis.CONCLUSION The method of treatment for whole pleural malignancy by combination of 60Co and electron beam irradiation was well tolerated and effective clinically.更多还原