三维适形放射治疗加NP方案化疗治疗晚期非小细胞肺癌

Treatment of advanced non-small cell lung cancer with three-dimensional conformal radiotherapy plus NP scheme synchronization chemotherapy

目的探讨提高局部晚期非小细胞肺癌(NSCLC)患者生存期的治疗方法。方法用三维适形放射治疗(3D-CRT)加长春瑞滨(NVB)、顺铂(DDP)方案(NP)同期化疗治疗局部NSCLC。12例患者作为治疗组:诱导化疗用NVB25mg/m2加入生理盐水(NS)100ml,快速静脉滴注,d1,d5;DDP80mg/m2,静脉滴注,d1,d2,d3;28d为1周期,连续2周期。放疗开始后同期化疗,用NVB25mg/m2加NS100ml静脉滴注;DDP25mg/m2加NS500ml静脉滴注,放疗的间隙每周给药1次,给药2周,休息2周,直至放疗结束。放射治疗:第2周期诱导化疗结束后开始常规放疗,每次2Gy,每周5次,TD40Gy/4周。结束后,予以3D-CRT局部加量,每次2Gy,每周5次,TD30～34Gy/3～3.5周。14例患者作为对照组:诱导化疗及常规放射治疗同治疗组。结束后予以常规放射治疗缩野至原发灶及转移的淋巴结,追加2600～3000Gy/2.6～3周。放疗结束后序惯化疗,即予以2～4周期的NP方案,剂量及给药方法同诱导化疗,28d为1个给药周期。结果治疗组1、2年观察期末生存率为92%和61%,对照组为57%和14%(P<0.05)。两组患者均没有发生严重的放化疗毒副反应。结论3D-CRT加NP方案同期化疗治疗局部晚期NSCLC可以提高肿瘤的局部控制率,提高疗效。

Objective To study the treatments for proloning the survival period and improving the life quality of patients with local advanced non-small cell lung cancer （NSCLC）. Methods Twelve patients in study group received induction chemotherapy 2 cycles navelbine （25 mg/m^2 d1, d5 ） and cisplatin （80 mg/m^2 d1 or 25 mg/m^1 d1-3 ） followed by conventional radiotherapy （2 Gy/f, 5 f/w, totally 40 Gy）, then by three-dimensional conformal radiotherapy boosted to TD 30 to 34 Gy in conventional fractionation completed in 3 to 3. 5 weeks. The patients were received chemotherapy with navelbine （25 mg/m^1 d1, d8 ） and cisplatin （ 25 mg/m^2 d1, c18 ） for every 28 days in radiotherapy interval. Fourteen patients in control group received induction chemotherapy and conventional radiotherapy as in study group, then followed by conventional radiotherapy with shrinkage fields covering the primary tumor and metastatic lymph node region had boost to 26 to 30 Gy in 2. 6 to 3 weeks. Two to four courses sequential chemotherapy of NP scheme were performed after radiotherapy in the patients who had not received any chemotherapy duving radiotherapy. Results The 1-and 2-year survival rates were 92% and 61% in study group, and 57% and 14% in control group, respectively （P〈0. 05）. All patients tolerated the toxic and side effects and completed treatment plan in the two groups. Conclusions 3D-CRT plus NP scheme synchronization chemotherapy for NSCLC may improve the local control rate and the survival period.