动态调强放疗同步化疗联合辅助化疗治疗Ⅲ期非小细胞肺癌

Concomitant Dynamic IMRT and Chemotherapy Combined With Accessory Chemotherapy for Ⅲ Stage NSCLC

目的探讨动态调强适形放射治疗(IMRT)同步TP方案(泰素+卡铂)化疗联合NP方案(诺维本+顺铂)辅助化疗治疗Ⅲ期非小细胞肺癌(NSCLC)的可行性,近期疗效和不良反应。方法对2005-06/2007-03收治的经病理学(纤维支气管镜活检)或细胞学(痰脱落细胞学或肺穿刺细胞学)证实的63例Ⅲ期NSCLC患者(除外有锁骨上淋巴结转移者),采用动态调强适形放射治疗(IMRT)同步TP方案(泰素+卡铂)化疗联合NP方案(诺维本+顺铂)治疗。结果按WHO通用的实体瘤疗效评价标准评价,完全缓解21例,部分缓解28例,无变化7例,进展7例,总有效率77.8%。Ⅲa/Ⅲb分组近期疗效经Mann-Whitney U检验两组有统计学差异(P=0.019)。根据RTOG标准,急性放射性肺炎、食道炎Ⅰ-Ⅱ级反应分别为65%和82%,Ⅲ级反应分别为35%和18%。按照WHO标准,化疗不良反应均在Ⅱ-Ⅲ级内。动态设计IMRT计划在提高肿瘤剂量的同时减少了治疗侧肺容积剂量,有效降低了放射性肺损伤。结论动态调强适形放疗同步TP方案化疗联合NP方案辅助化疗治疗Ⅲ期NSCLC方法可行,动态设计IMRT计划有助于减少治疗侧肺容积剂量,提高了TCP,降低了NTCP,不良反应患者可以耐受。

Objective To evaluate the efficacy and toxicicy of concomitant IMRT and chemotherapy combined with accessory chemotherapy for Ⅲ stage non-small cell lung cancer （NSCLC）. Methods 63 cases with Ⅲ stage NSCLC diagnosed by pathology from Jun. 2005 -Mar. 2007 were treated. Results A total of 63 patients were enrolled, among whom 21 cases were complete remission, 28 cases partial remission, 7 no change, and 7 made progress, with overall effective rate of 77.8%. The response rate was different between Ⅲa and Ⅲb（P =0. 019）. IMRT promoted doses in tumor and reduced side effects. Conclusion Concomitant IMRT and chemotherapy combined with accessory chemotherapy for Ⅲ stage NSCLC can improve the local control rate and the initial response rate with tolerable toxity.