后程加速超分割放射治疗Ⅲ期非小细胞肺癌81例疗效分析

The Analyses of 81 Patients with Stage Ⅲ Non-Small Cell Lung Cancer Treated by Late Course Accelerated Hyperfractionation Radiotherapy

目的 探讨后程加速超分割放射治疗非小细胞肺癌的临床价值。方法81例非小细胞肺癌患者进入本研究,随机分为后程加速超分割放疗组（LCAH组）、常规放疗组（CRT组）。LCAH组常规放射治疗40Gy后,改用后程加速超分割推量治疗,1.5Gy次/,2次/天,5天/周,总剂量至70Gy。CRT组常规放射治疗68～72Gy。结果所有患者均完成全部疗程。CRT组CR 5.1%,PR53.8%,总有效率（CR＋PR）为58.9%;LCAH组CR 11.9%,PR 69%,总有效率（CR＋PR）为78.6%。两组比较差异无统计学意义（P〉0.05）;毒性反应Ⅲ级放射性食管炎：LCAH组4例,CRT组1例;Ⅲ级肺损伤：LCAH组2例,CRT组1例;1,3年生存率分别为53.8%（21/39）,12.8%（5/39）和76.2%（32/42）,19.1%（8/42）。1年生存率两组间差异有统计学意义（P〈0.05）,3年生存率两组差异无统计学意义（P〉0.05）。结论后程加速超分割放射治疗非小细胞肺癌有较好的近期疗效,绝大多数患者可以耐受该方法的急性毒性反应。远期疗效和晚期并发症有待进一步随访观察。

Objective To evaluate the clinical value of late course accelerated hyperfractionation radiotherapy（LCAH） in stage Ⅲ non-small cell lung cancer（NSCLC）. Methods 81 patients with stage Ⅲ NSCLC were randomized into two groups： accelerated hyperfractionation radiotherapy （LCAH group） and conventional radiotherapy （CRT group）. Patients in LCAH were treated by conventional radiotherapy with 40Gy, then by LCAH to the total dose of 70Gy（ a fraction of 1.5Gy at twice daily,5 days per week）. Patients in CRT group rec＇eived conventional radiotherapy for 68 - 72Gy. Results All of the patients finished the whole treatment course. In CRT group, CR was 5. 1% , PR 53.8% and total effective rate （CR ＋ PR） 58.9%. In LCAH group, CR was 11.9% ,PR 69% and total effective rate （CR ＋ PR）78.6%. There was no difference between the two groups. Complication： In stage Ⅲ ,esophagitis there were 4 cases in LCAH group and 1 case in CRT group, in stage Ⅲ, 2 cases in LCAH group and 1 case in CRT group. 1 year survival rates were 76.2% （32/42）, 19.1% （8/42）in the two groups, there was a significant difference between the two groups（ P 〈 0.05 ）. 3 years survival rates were 53.8% （21/39）, 12.8% （5/39）in the two groups, there wasn＇t a significant difference between the two groups（ P 〉 0. 05）. Conclusions There was a good recent result in stage Ⅲ non-small cell lung cancer treated by late course accelerated hyperfractionation radiotherapy. Patients could endure the complication of LCAH. Long stage result and advanced complication are under follow up.