三维适形联合立体定向放射治疗局部晚期非小细胞肺癌临床研究

Three-dimensional conformal radiotherapy combined with stereotactic radiotherapy for locally advanced non-small cell lung cancer:efficacy and complications

目的研究三维适形联合立体定向放射治疗局部晚期非小细胞肺癌(NSCLC)的疗效和放射反应。方法68例局部晚期NSCLC患者随机分成A组和B组,A组33例采用三维适形放射治疗(3DCRT),总剂量66～70Gy/33～35次。B组35例3DCRT60Gy后采用立体定向放射治疗(SRT)20Gy/4次,每次500cGy,隔日一次。结果A、B两组患者的总有效率分别为56.3%和80.0%,其中完全缓解率分别为9.4%和28.6%(P<0.05)。两组患者1、2年总生存率分别为65.6%和74.3%,以及46.8%和51.4%(P>0.05)。A组患者中位生存期12.6个月,B组患者中位生存期18.3个月。两组患者早期放射反应主要为I～II级放射性食道炎和骨髓抑制,后期放射反应主要为I～II级放射性肺炎,两组发生率接近。结论3DCRT联合SRT治疗局部晚期NSCLC的疗效优于单纯3DCRT。

Objective To evaluate the therapeutic efficacy of three-dimensional conformal radiotherapy （3DCRT） combined with stereotactic radiotherapy （SRT） and the radiation-induced complications in patients with locally advanced non-small cell lung cancer （NSCLC）. Methods Sixty-eight patients with locally advanced NSCLC were randomly divided into two groups, The 33 patients in groups A received 3DCRT at the total dose of 66 to 70 Gy in 33 to 35 fractions, and the 35 patents in group B received stereotactic radiotherapy （SRT） at the dose of 20 Gy in 4 fractions （500 cGy per fraction every other day） after 60 Gy 3DCRT. Results The total response rates in groups A and B were 56.3% and 80.0%, with the complete remission rates of 9.4% and 28.6%, respectively, both showing significant differences between the two groups （P〈0.05）. The 1- and 2-year survival rates of the patients in group A were 65.6% and 46.8%, respectively, which were comparable to those in group B （74.3% and 51.4%, respectively, P〉0.05）. The median survival time in groups A and B were 12.6 and 18.3 months, respectively. The major radiation-induced complications in the two groups included grade Ⅰ to Ⅱ acute radiation esophagitis and hematopoietic toxicity. The complications in later stages following the radiation were grade Ⅰ to Ⅱ radiation lung fibrosis, occurring at a similar incidence between the two groups. Conclusion The combination of 3DCRT and SRT produces better therapeutic effects than 3DCRT alone in patients with locally advanced NSCLC.