适形放疗联合NP化疗与单纯NP化疗治疗晚期非小细胞肺癌临床疗效分析

Clinical Effect Analysis of Conformal Radiotherapy Combined with NP Chemotherapy and NP Chemotherapy for Advanced Non-small Cell Lung Cancer

目的回顾分析适形放疗联合化疗与单纯NP方案化疗治疗晚期非小细胞肺癌的临床疗效和毒副作用。方法76例Ⅲ期和Ⅳ期非小细胞肺癌患者资料。单纯化疗组31例，接受单纯NP方案化疗。NP方案为诺维本25mg／m^2，d1，d8；DDP25mg／m^2，d1-3，21d为1周期。放疗联合化疗组45例，接受适形放疗联合NP方案化疗，NP方案化疗两周期后续行三维适形常规分割放疗，之后再行NP方案化疗。放射源为直线加速器X线，15MV，照射剂量36—66Gy。锁骨上区预防照射，8NeV电子线，20—30Gy。结果放疗联合化疗组有效率（RR）57．8％，其中3例达到完全缓解，单纯化疗组有效率（RR）32．3％，两组间P〈0．05，其差异有统计学意义。放疗联合化疗组中鳞癌RR65．6％，腺癌RR41．7％，P〈0．05，其差异有统计学意义；ⅢA、ⅢB和Ⅳ期RR分别为83．3％，61．1％和33．3％，P〈0．05，三者间差异有统计学意义，ⅢA期与Ⅳ期有效率P〈0．01，其差异有统计学意义；初治、复治RR为60．1％、20．0％，P〈0．05，其差异有统计学意义。单纯化疗组中鳞癌与腺癌、ⅢB期与Ⅳ期、初治与复治之间有效率差异无统计学意义。放疗联合化疗组的中位疾病进展时间（TTP）为178a（60-446d）。单纯化疗组的中位TTP为82d（25—233d）。放疗联合化疗组的毒副反应较单纯化疗组多一些，重一些，主要毒副反应为骨髓抑制、胃肠道反应、放射性肺炎和放射性食管炎，均可以通过相应措施予以纠正、缓解。结论适形放疗联合NP方案化疗较单纯NP方案化疗对晚期非小细胞肺癌有较好的近期疗效，TTP也较长些，毒副反应能够予以纠正、缓解。

Objective To analyze retrospectively the clinical effects and side effects of conformal radiotherapy combined with NP chemotherapy and NP chemotherapy for advanced non-small cell lung cancer. Methods 76 patients with Ⅲ and Ⅳ stage non-small cell lung cancer were grouped. Chemotherapy group consisted of 31 patients, treated with NP chemotherapy. The NP regimen includes Navelbine （25mg/m^2, d1, d8） and DDP （25mg/m^2, d1-3） , repeated every 21 days. Radiochemotherapy group consisted of 45 patients, receiving three-dimensional conformal radiotherapy （3-DCRT） combined with NP chemotherapy. Conventional fraction 3-dimentional conformal radiotherapy was performed, using 15MV x-rays from linear accelerator, after 2 cycles of NP chemotherapy, with total dose 36 to 66 Gy. Then, two more cycles of NP chemotherapy were performed. Prophylactic supraclavicular irradiation was delivered, using 8MeV Electron Beam with total dose of 20 to 30,Gy. Results The overall response rate（RR） was 57.8% in the radio-chemotherapy group, with 3 patients achieved complete responses, 32.3% in the chemotherapy group, there was a significent difference （P 〈 0.05） between RR of the two groups. In the radio-chemotherapy group, RR was 65.6% in patients with squamous cell carcinoma, 41.7% in patients with adenocarcinoma,there was a statistical difference（P 〈 0.05） between RR of the two types. RR of the stage mA, mB and IV was 83.3%, 61.1% and 33.3% respectively, there were statistical differences（P 〈0.05） among RR of the three stages. RR was 60.1% in the patients with initially diagnosed, 20.0% with recurrence, P 〈 0.05. In the chemotherapy group, there was no statistics difference（P 〉0.05） between RR of patients with squamous cell carcinoma and with adenocarcinoma, patients of stage mB and IV, patients in initially diagnosed and in recurrence. Medium time to progression （TTP） was 178 days （60-446d） in the radio-chemotherapy group, while medium TTP was 82 days（25-233days） in the chemotherapy group. Toxicity side effects in the radio-chemotherapy group were more than those in the chemotherapy group. Major toxicity side effects included bone marrow suppression, gastrointestinal side effects ,radiation pneumonitis and radiation esophagitis, all of which could be relieved by corresponding measurements. Conclusion The response rate of comformal radiotherapy combined with NP chemotherapy is higher than NP chemotherapy alone for advanced non-small cell lung cancer, with tolerable toxicity side effects, and longer TTP.