三维适形加量放疗联合化疗治疗非小细胞肺癌的临床观察

Clinical observation on corvertional radiotherapy plus hig-dose three-dimensional conformal radiotherapy and chemotherapy in treatment of non-small cell lung cancer

目的:观察常规分割放疗基础上行三维适形加量放疗并联合化疗治疗非小细胞肺癌的可行性及疗效。方法:将68例Ⅱ～Ⅲ期非小细胞肺癌患者先予NP方案化疗(盖诺40mg,静脉注入,d1、d8;DDP40mg,静脉滴入,d1～d3)。鳞癌化疗1个周期,其他类型肺癌化疗2个周期。放射治疗的前半程为常规分割2Gy/次,剂量40Gy/20次后改用三维适形加量放疗5Gy/次,每次间隔1～2d,剂量30Gy/6次。锁骨上有淋巴结转移者采用6MVX线加电子线常规分割放疗至总量DT60Gy。放射治疗结束后根据患者情况再追加化疗2～4个周期。结果:68例患者全部完成治疗计划,其中肺原发灶完全缓解(CR)12例,部分缓解(PR)49例,稳定无进展(NR)7例,总有效率为84.7%。Ⅰ～Ⅱs级急性放射性食管炎64%,Ⅲ级急性放射性食管炎5%,急性放射性气管炎、肺炎35%,急性胃肠道反应64%,治疗期间白细胞下降的发生率100%,升白治疗有效。后期毒副反应主要是放射性肺纤维化38%。1、2年生存率分别为71.2%和52%,1、2年局控率为85%和71%。结论:在常规分割放疗基础上行三维适形加量放疗并联合化疗治疗非小细胞肺癌有较好的近期疗效,毒副反应可耐受,值得进一步观察和推广。

OBJECTIVE：To observe the feasibility and effect of corvertional radiotherapy plus hige dose three-di mensional comformal radiotherapy （3DCRT） and chemotherapy in the treatment of non-small cell lung cancer （NSCLC）. METHODS： Sixty-eight patients with stage Ⅱ - Ⅲ NSCLC were treated with chemotherapy and radio therapy in turn, one or two cycles of NP [navebine （40 mg d1 ,ds） and cisplation （40 mg d1 -d3）] were used before the radiotherapy. The radiotherapy was divided into two phases： 40 Gy in 20 fractions as the phase using convertional technigue,and then 30 Gy in 6 fractions as the second phase using 3DCRT technigue. After the radiotherapy, the chemotherapy would be used for two or four cycles by patients＇ tolerance. RESULTS： The overall response rate of the groups was 84.7% （12CR, 49PR）. The major acute toxicity was leucopenia（100% ）, but the adverse reaction could be tolerable by using G-CSF. The major chronic toxicity was radioacting fibrous changes of lung （38%）, and 1 year, 2- year survival rates were 71.2% and 52%, and 1-year, 2- year localcontrol rates were 85 % and 71%. CONCLUSION： It has better effect to use the treatment of convertional ra diotherapy plus hige-does 3DCRT and chemotherapy on NSCLC, and the toxicity can be accepted.