同期化疗合并后程加速超分割放射治疗局部晚期非小细胞肺癌的临床观察

Clinical observation on concurrent chemotherapy combined with late course hyperfractionated accelerated radiotherapy in non-operative non-small cell lung cancer

将 5 2例局部晚期非小细胞肺癌 (non smallcelllungcancer,NSCLC)患者随机分为化放组和单放组 ,每组 2 6例。化疗方案为紫杉醇 13 5mg/m2 ,d1、d2 2 ;顺铂 2 0mg/m2 ,d1～d5、d2 2 ～d2 6,化疗同步60 Co体外照射 ,常规分割照射DT40Gy时缩野行加速超分割照射 ,DT1 5Gy/次 ,2次 /d ,2次间隔 >6h ,每周 5d ,照射 9d ,DT2 7Gy ,总剂量DT67Gy/ 6w。化放组CR、PR、NC和PD分别为 3 4 6% ( 9/ 2 6)、 5 3 8% ( 14 / 2 6)、7 7% ( 2 / 2 6)和 3 9% ( 1/ 2 6) ,有效率CR +PR为88 4% ( 2 3 / 2 6) ;单放组CR、PR、NC和PD分别为 19 2 % ( 5 / 2 6)、46 2 % ( 12 / 2 6)、2 3 1% ( 6/ 2 6)和 11 5 % ( 3 / 2 6) ,有效率CR +PR为 65 4% ( 17/ 2 6) ,P <0 0 5。化放组 1、2年生存率及中位生存时间分别为 69 2 %、3 8 5 %和 19个月 ,单放组分别为 46 1%、19 2 %和 12个月 ,P <0 0 5。化放组白细胞减少发生率 88 5 % ( 2 3 / 2 6) ,脱发发生率 10 0 % ,放射性食管炎 3 4 6% ( 9/ 2 6) ,放射性肺炎 2 3 1% ( 6/ 2 6) ;单放组白细胞减少发生率 3 0 8% ( 8/ 2 6) ,放射性食管炎 3 0 8% ( 8/ 2 6) ,放射性肺炎 19 2 % ( 5 / 2 6)。初步研究结果提示 ,紫杉醇

Concurrent chemotherapy with late course hyperfractionated accelerated radiotherapy (CCT+LCHAR) group,26 cases and LCHAR alone group,26 cases.The chemotherapy region was taxel 135 mg/m 2, intravenous infusion 3 hours, d 1,d 22 , DDP 20 mg/m 2 d 1-d 5, d 22 -d 26 . The patients received a fraction of 2 Gy daily, 5 days per week, to total dose of 40 Gy during the conventional fractionated radiotherapy, and then followed by LCHAR: 1.5 Gy, twice daily, with the interval of 6-8 hours between fractions to total dose of 67 Gy/6 weeks. The overall response rate,the 1- and 2-year survival rates were 88.4%, 69.2%, 38.5% in the CCT+LCHAR group and 65.4%, 46.1%, 19.2% in the LCHAR group,P<0.05. The median survival time was 19 months and 12 months in the CCT+LCHAR group and LCHAR group, respectively,P<0.05. The frequencies of side effects such as leukocytopenia, pneumonitis, esophagitis, were 88.5%,23.1%,34.6% in the CCT+LCHAR group and 30.8%,19.2%,30.8% in the LCHAR group, respectively. There was no ocurrance of Ⅳ degree toxicities in all patients. The concurrent chemotherapy combined with late course hyperfractionated accelerated irradiotherapy could be tolerated with the assist treatment of G-CSF. The immediate response was encouraging.