三维适形放射治疗联合同步及诱导化疗治疗中晚期非小细胞肺癌疗效分析

Efficacy of three-dimensional conformal radiotherapy combined with concurrent chemotherapy or induction chemotherapy for locally advanced non-small cell lung cancer

目的:对比三维适形放射治疗联合同步化疗及诱导化疗治疗中晚期(Ⅱb～Ⅲb期)非小细胞肺癌(NSCLC)的疗效,探讨更为有效的治疗中晚期肺癌的方法.方法:2002-01/2006-12共91例年龄28～70岁能够接受放射治疗且经病理证实的中晚期非小细胞肺癌患者按入院先后顺序分为两组,同步化疗联合三维适形放射治疗组(同步组)46例,采用紫杉醇联合顺铂:顺铂20mg/m2,d1～5,4wk后重复1次;紫杉醇30mg/m2,每周第1日放疗前静脉滴注,连用6wk,化疗第1日即开始行放射治疗,总剂量为60～70Gy,6～7wk完成.诱导化疗联合三维适形放射治疗组(诱导组)45例,采用紫杉醇联合顺铂:顺铂100mg/m2,d1,紫杉醇175mg/m2,d1,4wk为1个周期,共化疗2～4个周期;完成全身化疗3wk后行三维适形放射治疗,总量60～70Gy,6～7wk完成.同步组和诱导组分别有43例、44例在完成放疗1mo后给予2～3周期以顺铂及紫杉醇为主的联合化疗.结果:全组病例从治疗开始之日计算,随诊时间12～72mo,中位随访时间50.4mo,失访3例,随访率为96.7%.近期疗效以放射治疗结束后1～2mo的CT结果进行对比分析,诱导组完全缓解率(CR)占35.6%,部分缓解率(PR)占48.9%,无变化+病变进展占15.5%;同步组分别占43.5%,45.6%,10.9%,两组的近期疗效(CR+PR)有效率差异无统计学意义(χ2=0.436,P=0.509).中位生存期诱导组为13.0mo,同步组为22.2mo.1,2,3a生存率诱导组分别为68.8%,24.4%,15.5%,同步组分别为76.1%,47.8%,32.6%,两组生存率差异有统计学意义(χ2=7.06,P=0.008).毒副反应方面,同步组高于诱导组,尤以造血系统毒性明显,但能为绝大多数患者耐受.结论:三维适形放射治疗联合同步化疗能延长中晚期非小细胞肺癌患者的中位生存期,提高患者的生存率.

AIM： To evaluate the efficacy of induction chemotherapy plus three-dimensional conformal radiotherapy（3D-CRT） （ICRT） and 3D-CRT plus concurrent chemotherapy（CCRT） for locally advanced non-small cell lung cancer （NSCLC, IIb-IIIb）. METHODS： A total of 91 patients of locally advanced NSCLC who were admitted in our hospital from January 2002 to December 2006 were randomized into 2 groups： ICRT group （45 patients ） was given induction chemotherapy with cisplatin（ DDP, 100 mg/ m^2, d1 ） and paclitaxel（ 175 mg/m^2, d1 ） every 4 weeks for 2 -4 cycles followed by 3D-CRT; CCRT group （46 patients） received 3D-CRT plus concurrent chemotherapy with DDP （20 mg/m^2, d1 -5） and paclitaxel （30 mg/m^2, d1 ） every week for 2 cycles. In the two groups, 3D-CRT was given a total dose of 60 - 70 Gy in 6 - 7 weeks. RESULTS ： One patient was excluded from ICRT group because of development of distant metastases, and 3 patients were excluded in CCRT group due to acute complications or other diseases. The follow-up ranged from 12 -72 months （mean 50.4 months）. In ICRT group, the complete response （CR） rate was 35.6%, partial response（PR） rate was 48.9%, and non-response （NR） plus progressive disease （PD） rate was 15. 5%; in CCRT group, CR, PR and NR ＋ PD rates were 43.5% , 45.6% and 10.9%, respectively. The overall response rate（ CR ＋ PR） of ICRT group and CCRT group were 84.5% and 89.1% （ χ^2 = 0. 436, P = 0. 509） , respectively. The median survival period were 13.0 months in ICRT group and 22.2 months in the CCRT group（t =2. 104, P =0. 038）. The 1-, 2- and 3-year survival rates were 68.8% , 24.4% , 15.5% in the ICRT group and 76. 1% , 47.8% , 32.6% in CCRT group; the difference in the survival rates was significant（χ^2 = 7.06, P =0. 008）. More serious toxic responses were found in the CCRT group, but they were able to be tolerated in most patients. CONCLUSION： The median survival period can be significantly prolonged and the survival rate be improved also with 3D-CRT and concurrent chemotherapy in the treatment of locally mid-advanced NSCLC.