Ⅲ期非小细胞肺癌同期NP方案化疗与后程大分割三维适形放射治疗

Late course accelerated hypofractionated three-dimensional conformal radiotherapy combined with NP concurrent chemotherapy for stage Ⅲ non-small cell lung cancer

目的探讨同期NP方案化疗与后程大分割三维适形放射(3DCRT)治疗Ⅲ期非小细胞肺癌的疗效及不良反应。方法60例Ⅲ期非小细胞肺癌(NSCLC)随机分成后程大分割3DCRT组(A组)和常规分割放疗组(B组)。A组先接受常规分割放疗(2Gy/次,5次/周)40Gy后2周行大分割适形放疗24～30Gy(4～5Gy/次,3次/周);B组均接受常规分割放疗至66Gy。两组均于放疗第1天起接受1周期NP方案化疗,放疗结束后接受3周期NP方案化疗。结果A、B组完全缓解(CR)率分别为26.7%、16.7%(P>0.05),部分缓解(PR)率分别为50%、30%(P<0.05),有效率(CR+PR)分别为76.7%、46.7%(P<0.05);1、2、3年生存率A组分别为83.3%、46.7%、36.7%,B组分别为46.7%、20%、16.7%,两组1～3年生存率比较差异有统计学意义。急性造血系统反应、放射性食管炎和放射性肺炎发生率相当。结论后程大分割三维适形放射治疗加化疗治疗Ⅲ期NSCLC的效果优于常规分割放疗,且不良反应相当。

Objective To evaluate the curative effects and side reactions or toxicity of late course accelerated hypofraetionated three dimensional eonformal radiation therapy（3DCRT）eombined with NP concurrent chemotherapy for stage Ⅲ non-small cell lung cancer （NSCLC）. Methods Sixty patients with stage Ⅲ NSCLC were randomized into 2 groups：late course accelerated hypofraetionated 3DCRT group（group A,30patients）and conventional fractionated radiation therapy group（group B, 30patients）. In group A,30 patients received a dose of 40Gy at 2 Gy per fraction,5 times a week,which followed by late course accelerated hypofractionated 3DCRT with a dose of 24--30Gy at 4--5Gy per fraction,3 times a week. In group B,30 patients received a dose of 66Gy at 2 Gy per fraction,5 times a week. Chemotherapy, including vinorelbine and cisplatin, was given one cycle during radiotherapy and 3 cycles after radiotherapy for all patients. Results The overall response rate was 76.7% in group A and 46.7% in group B （P〈 0.05）. The 1-,2-,and 3-year survival rate was 83.3% ,46.7% ,36.6% in group A and 46.7%,20% ,16.7% in group B respectively. Group A had a higher survival date than group B in 3-years survival rate（P（0.05）. The acute hematological toxicities,incidence of acute radiation pneumonitis and esophagitis were similar in the two groups. Conclusion Compared with conventional fractionated radiation therapy,late course accelerated hypofractionated 3DCRT may be preferred for patients with stage Ⅲ NSCLC with tolerable toxicities.