大分割三维适形放疗联合化疗治疗Ⅲ期非小细胞肺癌疗效分析

Three Dimensional Conformal Hypofractionated Hige-dose Radiotherapy Combined with Chemotherapy for Stage Ⅲ Non-small-cell Lung Cancer

目的 探讨大分割三维适形放疗 ( 3DCRT)联合化疗治疗Ⅲ期非小细胞肺癌 (NSCLC)的疗效和毒副反应。方法 对 98例Ⅲ期NSCLC患者进行同期放化疗 :紫杉醇 4 0mg/m2 ,卡铂 (AUC =2 ) ,每周 1次 ,共 6周。 3DCRT从第 2周开始 ,6～ 8Gy/次 ,隔日一次 ,总剂量 6 0～ 6 6Gy ,2 0～ 2 4d完成。上述治疗后再进行两周期化疗 :紫杉醇 135mg/m2 ,卡铂 (AUC =5 ) ,第 1天 ,2 1天为 1周期。结果 98例患者全部完成治疗 ,肿瘤完全缓解 (CR) 30 .6 1% ,部分缓解 (PR) 5 2 .0 4 % ,总有效率 (CR +PR) 82 .6 5 %。纵隔转移淋巴结CR 36 .4 % ,PR 6 3.6 % ,总有效率 10 0 .0 %。 1、2年生存率分别为 77.5 5 %、5 6 .12 %。白细胞下降发生率 94 .88% ,其中Ⅲ、Ⅳ度白细胞下降 4 7.96 % ;2 9.5 9%出现Ⅱ～Ⅲ级血小板减少 ;放射性食管炎发生率 4 4 .89% ,其中 7.14 %为Ⅲ级放射性食管炎。放射性肺炎发生率为 11.2 2 % ,均为Ⅰ、Ⅱ级。结论大分割三维适形放疗联合化疗治疗Ⅲ期NSCLC有较好的疗效 。

Objective To explore the curative effects and side effects of three dimensional conformal hypofractionated hige dose radiotherapy(3DCRT) combined with chemotherapy for stage Ⅲ non small cell lung cancer(NSCLC).Methods 98 patients with Stage Ⅲ NSCLC were treated with 3DCRT and chemotherapy concurrently: Paclitaxel 40mg/m 2, Carboplatin AUC=2, once a week, 6 weeks totally; 3DCRT began from the second week at the total dose of 60～66Gy in a course of 20～24 days, 6～8Gy for each fraction. After that, two cycles of chemotherapy followed: Paclitaxel 135mg/m 2, d1, Carboplatin AUC=5, d1, one cycle lasting 21 days.Results The overall response rate (CR+PR) was 82.65% for the primary tumor and 100% for metastatic mediastinal lymphnodes. The 1 , 2 year survival rates were 77.55% and 56.12% . The leucopenia rate was 94.88% ( 47.96% Grades Ⅲ,Ⅳ). Blood platelet reduction of Grades Ⅱ,Ⅲ happened in 29.59% cases. Acute radiation esophagitis occurred in 44.89% cases ( 7.14% Grade Ⅲ). Acute radiation pneumonitis was observed in 11.22% (GradesⅠ,Ⅱ).Conclusion 3DCRT combined with chemotherapy is effective for stage Ⅲ NSCLC and the side effects are tolerable.