吉西他滨与三维适形放疗同步治疗局部晚期非小细胞肺癌的临床观察

Clinical observation of gemcitabine and concurrent three-dimensional conformal radiotherapy (3D-CRT) in the treatment of locally advanced non-small cell lung cancer

目的 评价吉西他滨与三维适形放疗同步方案在局部晚期非小细胞肺癌治疗中的近期疗效和急性毒副反应。方法 2 0 0 2年 4月～ 2 0 0 3年 6月 ,采用吉西他滨与三维适形放疗同步治疗 2 8例不能手术切除的Ⅲ期非小细胞肺癌患者。化疗方案为吉西他滨 3 5 0mg/m2 ,第 1、8、15、2 2、2 9、3 6天。三维适形放疗放射源为 6MVX线 ,2Gy/(次·天 ) ,5 0Gy后缩野加量 ,总剂量DT 60～ 64Gy。有锁骨上淋巴结转移者 ,给予X线和电子线混合照射至DT 60～ 64Gy。 结果 近期结果显示 ,肺原发灶有效率为 89.3 % ( 2 5 /2 8) ,纵隔淋巴结转移灶有效率为 96.0 % ( 2 4/2 5 ) ;肺鳞癌有效率为 94.7% ( 18/19) ,腺癌有效率为 77.8% ( 7/9)。急性毒副反应主要是骨髓抑制、胃肠道反应和轻中度放射性食管炎、放射性肺炎 ,经处理后均可耐受。结论 吉西他滨与三维适形放疗同步方案能提高局部晚期非小细胞肺癌的近期疗效 ,且急性毒副反应无明显增加 。

Objective To evaluate the clinical effect of gemcitabine and concurrent three-dimensional conformal radiation therapy (3D-CRT) for locally advanced non-small cell lung cancer (NSCLC). Methods From April 2002 to June 2003, 28 patients with inoperable stage Ⅲ NSCLC were treated with gemcitabine and 3D-CRT simultaneously. Chemotherapy consisted of intravenously gemcitabine 350 mg/m 2 on days 1, 8, 15, 22, 29, 36. 3D-CRT was delivered up to a total dose of 60--64 Gy with a 2.0 Gy dose fraction per day, 5 days per week. Results The overall response rates of primary tumor and mediastinum metastatic node were 89.3%(25/28) and 96.0%(24/25) respectively, and 94.7%(18/19) and 77.8%(7/9) for squamous cell carcinoma and adenocarcinoma respectively. The acute side effects of patients were mostly myelosuppression, nausea, vomiting, radiation-induced esophagitis and pneumonitis (RTOGⅠ/Ⅱ), however, all of them were cured. Conclusion Concurrent application of gemcitabine and 3D-CRT can improve the overall response rate for locally advanced NSCLC without aggravating the side effects.