后程三维适形放疗同步化疗治疗Ⅲ期非小细胞肺癌疗效观察

Observation of the efficacy of late-course conformal radiotherapy with concurrent chemotherapy in treatment of stage-Ⅲ non-small cell lung cancer

目的观察后程三维适形放疗(late course conformal radiotherapy,LCCR)配合同步化疗治疗Ⅲ期非小细胞肺癌(NSCLC)的近期疗效与急性毒副反应。方法48例经组织或细胞病理学证实的Ⅲ期非小细胞肺癌患者随机分为两组,每组24例。A组为治疗组,采用后程三维适形推量放疗加同步NP方案化疗:NVB(国产去甲长春花碱)30 mg/m^2,d1、8;DDP 25 mg/m^2,d1～3,21～28 d为一疗程,共4疗程。第一疗程开始即同步放疗,先普通放疗常规分割剂量前后对穿野照射达D_T 40 Gy,后给予三维适形放疗推量达27～30 Gy,3 Gy/次,隔日1次,共9～10次,治疗总量达67～70 Gy;B组为对照组,采用与治疗组相同的化疗方案及疗程,放疗在常规分割前后对穿野照射D_T 40 Gy后于X线模拟定位机下改斜野,避开脊髓,加量D_T 24～28 Gy,总D_T达60～68 Gy。结果48例全部完成治疗计划。治疗组总有效率为83.3%,对照组为54.2%,两组间差异有显著性(P<0.05)。治疗组1年生存率53.4%,对照组42.8%(P>0.05)。治疗组白细胞下降发生率为75.0%,对照组为79.2%;治疗组Ⅲ、Ⅳ度白细胞下降率为45.8%,对照组为54.2%,两组间差异无显著性(P>0.05)。治疗组放射性食管炎和放射性肺炎发生率分别为29.2%和8.3%,均为Ⅰ、Ⅱ级;对照组Ⅰ、Ⅱ级放射性食管炎和放射性肺炎发生率分别为58.3%和33.3%,Ⅲ级放射性食管炎和放射性肺炎分别为8.3%和12.5%,两组比较差异有显著性(P<0.05)。结论后程三维适形放疗配合化疗治疗Ⅲ期非小细胞肺癌有较好的近期疗效,且毒副反应小,故能为多数患者耐受。

Objective To observe the efficacy of late-course conformal radiotherapy with concurrent chemotherapy in treatment of stage-Ⅲ non-small cell lung cancer（NSCLC）. Methods Forty-eight cases of stage-Ⅲ NSCLC were randomized into two groups. In group A, the patients were treated with chemotherapy （ NVB 30 mg/m^2 , d1, 8, DDP 25 mg/m^2 , d1-3 ）, with a cycle consisting of twenty-one to twenty-eight days ,for four cycles and concurrent radiotherapy（ conventional radiotherapy with 40Gy followed by 3D-CRT, 3D-CRT was given with 3 Gy per fraction, one time every other day, to a total dose of 67-70 Gy）. In group B, the patients received chemotherapy（ like group A） combined with total conventional radiotherapy,the total dose was 60-68 Gy. Results All 48 cases completed the treatment schedules . The total effective rate was 83.3% in group A and 54. 2% in group B. The difference between two groups was statistically significant （ P 〈 0. 05 ）. Rate of WBC decrease in group A was 75.0% , of which the rate of degrees Ⅲ and Ⅳ deerease in white blood cells was 45.8%. The rate of WBC decrease in group B was 79. 2%, of which the rate of degrees Ⅲ and Ⅳ deerease in white blood cells was 54. 2%. The incidence rates of radiation esophagitis and pneumonia were 29. 2% and 8.3% in group A, and 58. 3% and 33.3% in group B respectively. Conclusions Late-course three-dimensional eonformal radiotheraov combined with chemotheranv in the treatment of stage-Ⅲ NSCLC can be well tolerated by most cases and has good short-term efficacy.