“美国非小细胞肺癌NCCN指南，该指南旨在给患者提供治疗信息，帮助患者从“0”到“1”认识肺癌，找到适合的治疗方案。本指南有些建议也许不适合你，你的医生可能会根据你的情况和其他因素制定不一样的治疗方案。”
本公众号将非小细胞肺癌NCCN指南重新整理拆分，将以中英文在公众号连载的方式发布，本指南不能做任何商业用途，转载请联系本公众号。
译者：朱志华、梅伟健
Part5.3 放射治疗
最常使用高能x射线治疗肺癌。x射线破坏癌细胞的DNA。这要么杀死癌细胞，要么阻止新的癌细胞产生。放射治疗可用于肺癌的所有阶段。在某些情况下，它可能被用来治疗癌症。在其他情况下，它被用来减少症状。它可以单独使用或与其他治疗同时进行。阅读第6部分或第7部分，了解什么时候和哪种类型的放射治疗是一种选择。
一名治疗肺癌的放射肿瘤医生需要制定治疗方案。放射肿瘤学家是治疗癌症的专家。他或她会设计治疗以满足你的需要。
Side effects are unhealthy or unpleasant physical or emotional responses to treatment. You may experience side effects from the anesthesia or surgery. General anesthesia may cause a sore throat from the breathing tube, nausea with vomiting, confusion, muscle aches, and itching.
Common side effects of any surgery are pain, swelling, and scars. Pain can be intense after lung surgery. Pain and swelling often fade away in the weeks after surgery. Numbness near the surgical area may be long-lasting. There is a chance of infection, which may cause pneumonia. There’s also a chance of a collapsed lung (pneumothorax).
Not all side effects of surgery are listed here. Please ask your treatment team for a complete list of common and rare side effects. If a side effect bother you, tell your treatment team. There may be ways to help you feel better.
1、支持性治疗
支持性治疗并不旨在治疗癌症但是旨在改善生活质量。它也被称为姑息治疗。它可以满足许多需要。一个例子是对身体和情绪症状的治疗。支持性治疗也可以帮你进行治疗决策，因为你可以有多一个选择。它还可以协调不同治疗之间的关系。与你的治疗团队沟通，为你制定最佳的支持性治疗方案。
Supportive care doesn’t aim to treat cancer but aims to improve quality of life. It is also called palliative care. It can address many needs. One example is treatment for physical and emotional symptoms.
Supportive care can also help with treatment decisions as you may have more than one option. It can also help with coordination of care between health providers. Talk with your treatment team to plan the best supportive care for you.
2、体外放射
对肺癌最常见的辐射方法是EBRT(体外放射疗法)。一个大型机器能生成用于治疗的高能x射线。这台机器叫做直线加速器。参见图10。
For lung cancer, the most common radiation method is EBRT (external beam radiation therapy). A large machine makes high-energy x-rays used for treatment. This machine is called a LINAC (linear accelerator). See Figure 15.
辐射光束很快会穿过你的身体。治疗结束后，你体内不会有辐射。你不需要避开别人。
The radiation beams will move through your body very quickly. There is no ongoing radiation inside of you after the treatment session. You will not have to avoid people.
执行放射治疗需要一个团队的人。包括医生、医学物理学家、剂量测量师、护士和放射治疗专家。您的团队将共同设计您的治疗方案并提供治疗。
It takes a team of people to perform the radiation therapy. The radiation team consists of doctors, medical physicists, dosimetrists, nurses, and radiation therapists. Your team will work together to design your treatment plan and provide treatment.
3、准备放疗计划
准备放疗计划需要标出你的治疗区域。这个过程称为模拟。它包括进行成像扫描。在扫描期间你的身体将被股东在治疗所需的位置。扫描只用于制定治疗计划。
A planning session is needed to map out your treatment. The planning process is called simulation. It involves getting an imaging scan. During the scan, your body will be in the position that is needed for treatment. The scan is only used for treatment planning.
至少,CT扫描应该用于模拟。4d-ct(四维计算机断层扫描)是理想的可以排除呼吸运动影响的检查。对比剂可用于改善某些肿瘤的扫描。这些肿瘤位于肺的内部三分之二部分或在淋巴结中。
At minimum, a CT scan should be used for simulation. 4D-CT (four-dimensional computed tomography) is ideal to account for tumor movement from breathing. Contrast may be used to improve scans of certain tumors. These tumors are in the inner two-thirds of the lung or are in lymph nodes.
PET / CT扫描可以是有用的。当肺部出现塌陷或对比不能使用时，它可以帮助瞄准辐射光束。建议在治疗4周内进行PET / CT扫描。
A PET/CT scan can be useful. It can help to aim radiation beams when the lung has collapsed or contrast can’t be used. PET/CT scans within 4 weeks of treatment are advised.
你不必做很多准备。考虑穿容易脱去的衣服，因为你会穿上特定的服装。这个过程大约需要1小时。
You will not have to do much to prepare. Think about wearing easy-to-remove clothes since you’ll wear a hospital gown. The planning session takes about 1 hour.
模拟过程中,您将躺着面对一块板子。你的手臂会被高举过头顶。可以考虑做一个身体模具。彩色激光将被用来帮助定位。如果你的呼吸引起了很大的运动，可以使用运动控制方法。接下来，扫描将完成。医学物理学家或剂量测量师可能会对治疗计划进行更多的测量。
During simulation, you will lie face up on a table. Your arms will be raised above your head. A body mold may be made. Colored laser lights will be used to help position you. If your breathing causes large movements, motion control methods may be used. Next, the scan will be done. The medical physicist or dosimetrist may take more measurements for treatment planning.
这些图像将被转移到一个制定放疗计划的计算机。你的肺和其他器官会在扫描中看到。这些信息将告诉你 的放射肿瘤学家在哪些区域进行放射。
The images will be transferred to a treatment planning computer. Your lung and other organs will be seen on the scan. This information will show your radiation oncologist where to direct the radiation.
治疗目标确定后,你的皮肤将被标记为治疗区域。你的皮肤会用笔做记号。有时，设置的标记是用微小的永久性纹身做的。你的治疗区域照片将被拍摄。这些标记和照片将被用来作为你的日常治疗的定位标志。
After the treatment sites are set, your skin will be marked for treatment sessions. Your skin will be marked with a felt pen. Sometimes, set-up marks are made with tiny permanent tattoos. Photos of your set up will be taken. The marks and photos will be used to position you for daily treatments.
模拟后,放射团队将进一步制定你的治疗计划。通过在计算机上查看您的扫描结果，治疗计划将被制定。你的放射肿瘤学家将与一个放射剂测试员密切合作。他们将计划辐射光束的最佳剂量、数量和形状，以及治疗的数量。你的计划将保证能够治疗癌症，同时保留正常的组织。
After simulation, your radiation team will further plan your treatment. Plans will be made by viewing your scans on the treatment planning computer. Your radiation oncologist will work closely with a dosimetrist. They will plan the best dose, number and shape of radiation beams, and number of treatments. Your plan will be designed to treat the cancer while sparing normal tissue.
5、设定靶区
一旦你的治疗计划被指定下一步需要设置区域。这个环节有时被称为“port film”或彩排。设置区域将在在治疗室进行。
Once your treatment plan is made, a set-up session will be needed. This session is sometimes called “port film” day or dress rehearsal.The set-up session occurs in the treatment room.
放射治疗师将帮助你处在治疗的位置。设置的标记将用于定位。x射线治疗区域将被你的医生评估。这些x射线 (或port film)不用于治疗。当你的区域设置正确时，你的医生会批准你的治疗。
The radiation therapists will help place you in position on the treatment table. The set-up marks will be used for positioning. X-rays of the treatment fields will be taken and viewed by your doctor. These x-rays (or port films) are not for treatment.Your doctor will approve treatment when your set-up is correct.
6、治疗靶区
治疗之前,你的服装将会脱去到你的胸部以下水平。然后你将被安置在一个位置。如果有身体模具,你会躺在模具上。你必须在与设置区域相同的位置。胸部x光片将被用来确保这一点。
Before treatment, your hospital gown will be lowered off your chest.You will then be placed into position. If a body mold was made, you will lie on it on top of the treatment table. You must be in the same position that was approved at the set-up session. X-rays of your chest will be taken to assure this.
正形技术用于治疗肺癌。这些技术决定了癌症部位的辐射剂量，从而避免了损害健康的组织。你接受哪种技术取决于多种因素。这些因素包括癌症在你体内的位置。另一个因素是你的癌症中心能提供什么技术。共形辐射的类型包括:
Conformal techniques are used for treating lung cancer. These techniques shape the radiation dose to the cancer site to spare healthy tissue. Which technique you receive depends on multiple factors. These factors include where the cancer is in your body. Another factor is what techniques your cancer center has to offe. The types of conformal radiation include:
➢3D-CRT
三维适形辐射治疗提供一束与目标形状相匹配的光子光束。机器会绕着你转，瞄准肿瘤。治疗在6周内完成。
3D-CRT (three-dimensional conformal radiation therapy) delivers a photon beam that matches the shape of the target. The machine will move around you to target the tumor. Treatment is completed in about 6 weeks.
➢IMRT
调强放射治疗是hd-crt的一种形式。在治疗过程中，它进一步提高了波束的强度。
IMRT (intensity-modulated radiation therapy) is a form of 3D-CRT. It further modifies the beams intensity during treatment.
➢SABR
立体定向放疗通过非常精确,高剂量的光子束治疗癌症。接受SABR与技术很相似，但治疗在1-2周内完成。
SABR (stereotactic ablative radiotherapy) treats cancer with very precise, high-dose photon beams. Receiving SABR is much like other conformal techniques except treatment is finished in about 1 to 2 weeks.
➢SRS
立体定向放射外科通过精确,高剂量的光子束治疗大脑中的肿瘤。这种治疗方法比较知名的有射波刀和伽玛刀。治疗在1至2周内完成。
SRS (stereotactic radiosurgery) treats cancer in the brain with precise, high-dose photon beams. This treatment is known by CyberKnife and Gamma Knife. Treatment is completed in 1 to 2 weeks.
➢WBRT
全脑放疗使用少量的辐射治疗整个大脑。治疗在两周内完成。
WBRT (whole brain radiation therapy) uses small amounts of radiation to treat the entire brain. Treatment is completed in 2 weeks.
➢质子疗法
通过质子束流提供针对肿瘤的辐射以治疗癌症。治疗在6周内完成。
Proton therapy treats cancer with proton beams that deliver radiation mostly within the tumor. Treatment is completed in about 6 weeks.
肺肿瘤比身体其他部位的肿瘤更难被标记定位。这是因为呼吸导致肿瘤移动。IGRT(图像引导放射疗法)可以改善辐射束对肿瘤的靶向性。IGRT使用一种能提供辐射的机器，同时也能拍摄肿瘤的照片。照片可以在治疗前或治疗期间拍摄。这些照片将与在模拟过程中拍摄的照片相比。如果需要，将对你的身体位置或辐射光束进行改变。在治疗期间，你将独自一人在房间里。治疗师将在附近的房间里操作这台机器。他或她将能够看到、听到和与你在任何时候交谈。如果给予治疗，你可能会听到噪音。你不会看到或感觉到辐射。
A lung tumor is harder to target than some other tumors in the body. This is because breathing causes the tumor to move. IGRT (image-guidedradiation therapy) can improve how well the radiation beam targets the tumor. IGRT uses a machine that delivers radiation and also takes pictures of the tumor. Pictures can be taken right before or during treatment. These pictures are compared to the ones taken during simulation. If needed, changes will be made to your body position or the radiation beams. During treatment, you will be alone in the room. A therapist will operate the machine from a nearby room. He or she will be able to see, hear, and speak with you at all times. As treatment is given, you may hear noises. You will not see or feel the radiation.
治疗是在星期一到星期五每天一次。每次可以持续10到30分钟。一般情况下，每天同一时间接受治疗。
Treatment is given once a day on Monday through Friday. Each session can last between 10 to 30 minutes. In general, treatment is received at the same time each day.
7、内部放射
内部放射治疗是不太常见的辐射方法。这种方法也被称为短距离放射治疗。它包括在肿瘤周围或附近放置放射性物质。对于肺癌来说，内部辐射可以缩小阻塞气道的肿瘤。辐射通过插入到气道的塑料管来进行。治疗结束后，管子被移除。
The less common radiation method is internal radiation therapy. This method is also called brachytherapy. It involves placing a radioactive object in or near the tumor. For lung cancer, internal radiation can shrink a tumor blocking an airway. Radiation is given through a plastic tube that is inserted into the airway. The tube is removed after the treatment session.
8、副作用
放射治疗的副作用因人而异。辐射剂量和治疗时长等因素起着一定的作用。副作用是累积的。这意味着他们会慢慢地积累并在最后变得更糟糕。你的医生会在治疗期间每周检查你的情况。他或她会检查你的皮肤护理、药物和其他选择，以帮助你感觉更好。
Side effects from radiation therapy differ amon people. Factors like radiation dose and length of treatment play a role. Side effects are cumulative. This means they build up slowly and are worse at the end of treatment. Your doctor will check on you every week during treatment. He or she will review skin care, medicines, and other options to help you feel better.
9、急性反应
急性反应是那些放疗期间或放疗后不久出现的副作用。放疗后急性反应往往会得到改善。疲劳一种是急性反应。吞咽疼痛也可能发生。治疗部位的皮肤变化和脱发是常见的。
Acute effects are those that happen during treatment or shortly after the last session. Acute effects will generally improve after treatment. Fatigue is an acute effect. It may be painful to swallo . Skin changes and hair loss at the treatment site are expected.
通常,人们描述这种皮肤改变就像晒伤一样。与晒伤不同，皮肤的变化在治疗过程中会慢慢积累。你的皮肤会变红、变痛、变干。它也可能会发痒、变黑、脱落，有时还会裂开。
Often, people describe skin changes as like a sunburn. Unlike a sunburn, skin changes build up slowly during treatment. Your skin may become red, irritated, and dry. It may also itch, darken, peel, and sometimes crack open.
10、晚期反应
晚期反应发生在治疗后一段时间。有些不会消失。你的肺可能发炎。如果是这样,炎症在几个月内通常消失。疤痕组织可在肺内形成。疤痕组织可能引起气短和咳嗽。辐射会损害心脏，但这种情况很少见。
Late effects are those that happen after treatment. Some do not go away. Your lungs may become inflamed. If so, the inflammation often goes awa in a few months. Scar tissue may form in the lungs. The scar tissue may cause shortness of breath and a cough. Radiation may damage the heart but this is rare.
并不是所有放射副作用都被列在这里。请让你的治疗小组列出可能的副作用。如果一些副作用让你不安，请及时告诉你的治疗团队。可能有一些途径能够帮你变得更好。
Not all the side effects of radiation have been listed here. Please ask your treatment team for a complete list of side effects. If a side effect bothers you, tel your treatment team. There may be ways to help you feel better.
