后程立体定向适形放射治疗加化疗治疗局限性晚期非小细胞肺癌临床探讨

Clinical evaluation on late course stereotactic conformal radiotherapy with chemotherapy in partial advanced-staged non-small-cell lung carcinoma

目的 探讨后程立体定向适形放射治疗加化疗治疗局限性晚期非小细胞肺癌的疗效及患者的耐受性。方法 4 8例患者于治疗前 4周行常规分割放射治疗 (2 Gy/ d,每周 5次 ) ,肿瘤吸收剂量 (DT) :4 0 Gy,后 2周针对肿瘤局部行立体定向适形放射治疗 ,DT:2 4～ 30 Gy(分割剂量 4～ 5 Gy,每周 3次 ) ,与此同时 ,于第 1周和第 5周采用异长春碱 +顺铂 (NP)方案共 2周期 ,异长春碱 (NVB) :2 5 mg/ m2 第 1天和第 8天静脉推注 ,顺铂(DDP) :30 mg第 1天～第 3天静脉滴注。结果 全部患者均能完成治疗计划 ,完全缓解 (CR)占 17% ,部分缓解(PR)占 75 % ,总有效率 (CR+PR)为 92 %。 1、2、3年局部控制率分别为 88%、5 0 %和 36 % ,1、2、3年生存率分别为 88%、4 7%和 2 9%。急性造血系统和胃肠道的毒性反应较重 ,但对症处理后均能耐受。结论 后程立体定向适形放射治疗加化疗治疗局限性晚期非小细胞肺癌有提高总生存率的趋势。

Objective To evaluate the curative effect of and patient′s tolerance to the late course stereotactic conformal radiotherapy (LCSCR) with chemotherapy in partial advanced stage non-small-cell lung carcinoma.Methods Forty-eight patients were given the conventional fractionation radiotherapy (2 Gy daily,5 times a week),dose for tumor (DT) 40 Gy in the first 4 weeks and with stereotactic conformal radiotherapy to the primary tumor in the final 2 weeks,DT 24～30 Gy (4～5 Gy fraction dose,3 times a week),at the same time,chemotherapy (NVB+DDP scheme) given 2 periods,in the first and the fifth weeks,navelbine (NVB) 25 mg/m2 intravenous injection at the first and the eighth days,cisplatin (DDP) 30 mg from the first to the third days intravenous drip.Results All patients fulfilled the treatment plan, complete remission (CR) was 17%,partial remission (PR) was 75%.The overall response (CR+PR) was 92%.One-year,two-year and three-year local control rates were 88%,50% and 36% respectively.One-year,two-year and three-year survival rates were 88%,47% and 29% respectively.The acute hematological toxicities (such as leukopenia) and gastrointestinal toxicities were more severe,but well tolerated after symptomatic treatment.Conclusion The LCSCR with chemotherapy has a tendency to increase the total survival rate for partial advanced-staged non-small-cell lung carcinoma.