羟基喜树碱加超分割放射治疗Ⅲ期非小细胞肺癌的临床研究

Clinical study on hydroxycamptothecin concurrent hyperfractionated radiation therapy for stage Ⅲ non-small cell lung cancer

目的探讨羟基喜树碱加同步胸部超分割放射治疗不能手术的期非小细胞肺癌(NSCLC)的临床疗效和毒副反应。方法1998年10月～2002年5月,采用羟基喜树碱(HCPT)加同步超分割放射治疗不能手术的Ⅲ期NSCLC病人29例。化疗为放射治疗开始的前5d和放射治疗结束的前5d,分别应用HCPT10mg+NS250ml静点,每天1次,连用5天;胸部放射治疗方法为1.2GY/次,每天2次,总量为62.4～64.8GY/52～54次/36～38d。结果治疗结束后1个月评价近期疗效,有效率(CR+PR)为86.2%(25/29),其中CR率为24.1%(8/29),PR率为62.1%(18/29),稳定10.3%(3/29),进展3.5%(1/29)。远期疗效1年生存率为74.1%,2年生存率为60%,3年生存率为49%。毒副反应放射性食道炎(RTOG/EORTG)度为17.2%(5/29),度为65.5%(19/29),度为13.8%(4/29),度为3.5%(1/29);白细胞下降(WHO)度为51.7%(15/29), Ⅱ度为6.9%(2/29);血小板下降(WHO)度为13.8%(4/29)。结论小剂量羟基喜树碱加同步超分割放射治疗不能手术的Ⅲ期NSCLC病人,疗效较好,毒副反应小,病人完全可以耐受,是一种切实有效的治疗方法。

Objective To investigate the clinical effects and complications of hydroxycamptothecin（HCPT） concurrent hyperfractionated radiation therapy for stage Ⅲ inoperable non-small cell lung cancer（NSCLC）. Methods From October 1998 to May 2002,29 patients with stage Ⅲ inoperable NSCLC were treated with HCPT concurrent hyperfractionated radiation therapy. Patients were administered with HCPT 10 mg＋NS 250 ml,iv, gtt ,daily,in the first five days and the last five days during radiation therapy. Thoracic radiation was conducted for 1.2 GY,Bid,with total dose 62.4～64.8 GY in 52～54 fractions for 36～38 days. Results The response was evaluated one month after radiation therapy. Overall response rate（CR＋PR） was 86.2%（25/29）, with complete response rate （CR） 24.1% （7/29） ,partial response rate （PR） 62.1 % （18/29） ,stable disease rate（SD） 10. 3 %（3/ 29） ,and progress disease rate （PD） 3.25 （1/29）. 1-year overall survival rate was 74.10~, 2-year survival rate 60 %, and 3-year survival rate 49%. Complications included esophagitis,leukopenia and thrombocytopenia. Grade 1 esophagitis （RTOG/EORTG） occurred in 5 patients（17. 2%）;grade 2,in 19（65. 5%）;grade 3,in 4（13.8%）;grade 4,in 1（3.5%）. Grade 1 leukopenia（WHO） occurred in 15 patients （51.7% ） ;grade 2, in 2 （6.9% ）. Grade 1 thrombocytopenia （WHO） occurred in 4 patients （13. 8% ）. Conclusion Combined modality therapy with HCPT and concurrent hyperfractionated radiation is a valid treatment forstage Ⅲ inoperable NSCLC,which has a high response rate and acceptable toxicity.