三维适形放疗联合同期及序贯吉西他滨治疗老年Ⅲ期非小细胞肺癌的临床观察

Clinical study of three-dimensional conformal radiotherapy combined with concurrent and sequential gemcitabine chemotherapy for stage Ⅲ non-small cell lung cancer in elderly patients

目的：探讨三维适形放疗联合吉西他滨化疗治疗老年局部晚期非小细胞肺癌的临床研究。方法：85例Ⅲ期〉65岁老年非小细胞肺癌（NSCLC）患者随机分为治疗组（43例，采用三维适形放疗）和对照组（42例，采用常规放疗）。两组放射治疗均采用6／15MVX射线，2Gy／（次·d），5次／周，DT60～70Gy；放疗同期每周d1在放疗前4h给予400mg／m^2吉西他滨化疗；放疗结束后2周序贯化疗，d1、d8使用吉西他滨1000mg／m^2，每3周为1个周期，重复2～3个周期。结果：肺原发灶及纵隔转移淋巴结有效率治疗组完全缓解11例（25．6％），有效37例（86．1％）；对照组完全缓解4例（9．5％），有效28例（66．7％），P=0．035。所有患者中有效率肺鳞癌（87．5％）高于肺腺癌（66．7％），P=0．021。治疗组和对照组中位生存期分别为18．2和14．2个月，1和2年生存率分别为70．5％、35．5％和55．6％、26．6％，两组差异无统计学意义（P值分别为0．065和0．075）。结论：两组比较近期疗效及长期生存率提高，对鳞癌患者有更高的有效率，急性毒副反应较小，〉3级放射性食管炎及放射性肺炎发生率明显减低。

OBJECTIVE：To observe the efficacy and toxicity of three-dimensional conformal radiotherapy （3D-CRT） combined with concurrent and sequential gemcitabine chemotherapy for locally ad- vanced non-small cell lung cancer （NSCLC） in elderly patients. METHODS： Eighty five patients （〉 65 years） with stage Ⅲ NSCLC were enrolled and divided into three-dimensional conformal radiotherapy （3D-CRT） group （43 cases） and two-dimensional radiotherapy （2D-RT） group （42 cases）. All patients received gemcitabine at 400 mg/（m2 · wk） over 7 weeks concurrently combined with radiotherapy to 60-70 Gy in 30-35 fractions （6/15 MV X ray, 2 Gy/f evenyday, 5 f/week） and sequential gemcitabine（2 weeks after radiotherapy） at 1 000 mg/（m^2· wk） dl and d8 on days 1 and 8 of a 3-week cycle for 2-3 cycles. RESULTS：The overall response rate and complete response rate of primary tumor and mediastinum metastatic node were 86.1% and 25.6% in trial group, and 66.7% and 9.5% in control group （P=0. 035）. There was a overall response advantage for squamous cell carcinoma over adenocarcinoma （87.5 % vs 66.7%） （P=0. 021）. Median overall survival time was 18.2 and 14.2 months for trial group and control group, respectively. The 1- and 2-year survival rates were 70.5%, 35.5% in the trial group and 55.6%, 26. 6% in the control group, respectively （P were 0. 065 and 0. 075）. CONCLSIONS： It results in better response and survival time, with lower rates of more than grade 3 acute radiation-esophagitis and radiation-pneumonia. Also there is better response for squamous cell carcinoma than adenocarcinoma.