3DCRT配合化疗治疗早期非小细胞肺癌临床观察

Clinical observation of the three dimensional conformal radiation therapy(3D-CRT) combined with chemotherapy for treatment of early-stage non-small cell lung cancer

目的探讨拒绝手术或有手术禁忌证的早期非小细胞肺癌患者接受三维适形放射治疗（3DCRT）合并化疗的可行性。方法共60例经病理组织学和（或）细胞学确诊拒绝手术或有手术禁忌证的早期非小细胞肺癌患者，30例接受三维适形放射治疗配合NP方案化疗（治疗组）2～4个周期，另外30例单纯接受三维适形放射治疗（对照组），分割剂量3～6Gy／次，5次／周，放疗总量D，63—72Gy。靶区仅包括肿瘤原发灶和转移淋巴结。结果治疗组和对照组1，2，3年生存率分别为100％、90．5％、81．2％和100％、78．6％、56．5％。治疗组疗效较好，但无统计学差异（P〉0．05）。两组骨髓抑制发生率分别为100％和20．O％，差异有显著性（P〈0．05）。两组均未出现3级以上的放射性肺炎和放射性食管炎。结论3DCRT治疗对于拒绝手术或有手术禁忌证的早期非小细胞肺癌与手术治疗相比有近似的疗效，副作用可以耐受，配合化疗可以减少因远处转移引起的死亡，提高生存率，但因病例数较少仍需要进一步研究。

Objective To study the fiseability of treatment of early-stage non-small cell lung cancer （NSCLC） with three dimensional conformal radiation therapy （3D-CRT） combined with chemotherapy for patients who were not suitable for surgery due to medical problems or refused surgery. Methods A total of 60 patients with early were-stage NSCLC diagnosed by pathology or cytology were divided into two groups： 30 patients in the treatment group received chemotherapy（vinorelbine ＋ cisplatin） for 24 cycles and 3D-CRT and other 30 patients in the control group received 3D-CRT alone. The method of radiation was same in the two groups, with a total dose of 63-72Gy of radiation at 3-6Gy/fraction, 5 fractions/week. Only metastatic lymph nodes and primary tumor were included in the gross target volume. Results The 1-, 2-, and 3-year survival rates of the treatment and control groups were 100% ,90. 5% ,81.2% and 100% ,78. 6% ,56. 5% ,respectively. The survival rates of the treatment group were higher than those of the control group, but the difference had no statistical significance （ P 〉 O. 05 ）. The incidence rate of myelosuppression in the treat- ment and control groups were 100% vs 20% respectively , the difference had statistical significance （P 〈O. 05）. None of 60 patients developed grade 3 or worse pulmonary and esophageal toxicity. Conclusion Efficacy of 3D-CRT alone for early-stage inoperable NSCLC was similar to that of surgery. 3D-CRT combined with chemotherapy could improve survival rate by reducing the rate of distant metatasis, and the toxicity was tolerable. It is valuable to investigate more deeply.