伊立替康联合顺铂加同期适形放疗治疗12例非小细胞肺癌

Concomitant chemiotherapy of irinotecan plus cisplatin and conformal therapy for non-small cell lung cancer

目的探讨伊立替康／顺铂联合影像引导放疗对非小细胞肺癌（non—small cell lung cancer，NSCLC）的疗效和可行性。方法晚期NSCLC患者，行为状态评分为0～1，化疗方案为顺铂75mg／m^2（分3次于第1～3天给药），伊立替康设3个剂量组（50、60、70mg／m^2），分别于第1、8、15天给药，28d重复，共给予2—3个周期，同期采用kV—CBCT引导3D适形胸部放疗[2．0Gy／（次·d），总剂量66Gy]。结果伊立替康最大耐受剂量为60mg／m^2，剂量限制毒性为中性白细胞减少和食管炎。肿瘤缓解率75％，中位生存期11．5个月，随访未观察到症状性肺炎或食管炎发生。结论Ⅲ期NSCLC患者采用胸腔图像引导3D适形放疗66Gy联合同步伊立替康加顺铂化疗（伊立替康60mg／m^2，顺铂75mg／m^2），能为患者耐受。

Objective To study the feasibility of irinotecan plus cisplatin and image-guided radiotherapy in treatment of advanced non-small cell lung cancer （NSCLC）. Methods Twelve patients with locally advanced NSCLC and a performance status of 0 or 1 were eligible. The protocol consisted of escalating doses of irinotecan on days 1, 8 and 15, and cisplatin （75 mg/m^2, administered equal split doses on days 1 -3） for a total of 2 to 3 cycles combined with concurrent kV-CBCT guided 3D conformal radiotherapy （2.0 Gy daily for a total dose of 66 Gy）. Results The maximum tolerable dose of irinotecan was 60 mg/m^2, and the dose-limiting toxicity was neutropenia and esophagitis. Tumor response was observed in 75% cases. The median survival time of the 12 patients enrolled was 11.5 months, and no symptomatic pneumonitis or esophagitis presented. Conclusion Accompanied by conformal therapy, the tolerated dose that irinotecan at 60 mg/m^2 on days 1,8, 15, and cisplatin at 75 mg/m^2 is recommended for phase Ⅱ trial.