局部晚期非小细胞肺癌三维适型放疗同期NP方案化疗的临床分析

Clinical study on three-dimensional conformal radiation therapy and synchronization NP chemotherapy in locally advanced non-small cell lung cancer

目的:评价三维适型放疗联合NP方案同期化疗治疗不能手术切除的局部晚期(ⅢA、ⅢB)非小细胞肺癌(NSCLC)的疗效及毒副反应。方法:86例局部晚期NSCLC患者随机分为三维适型放疗同期化疗组(40例,同期组)及三维适型放疗、化疗序贯治疗组(46例,序贯组),放疗剂量64Gy,化疗方案为NP方案,长春瑞滨25mg/m2,静脉滴入,d1、d8;顺铂25mg/m2,静脉滴入,d1～d3,每3周重复1次。结果:86例全部完成治疗,同期组和序贯组总有效率分别为85.0%(34/40)和76.1%(35/46),P<0.05;1年生存率分别为67.5%(27/40)和60.9%(28/46),P<0.05。同期和序贯组Ⅲ～Ⅳ度骨髓抑制分别为22.5%(9/40)和21.7%(10/46),P>0.05;Ⅱ、Ⅲ级放射肺炎分别为10.0%(4/40)和8.7(4/46),P>0.05;Ⅱ、Ⅲ期放射性食管炎分别为22.5%(9/40)和19.5%(9/46),P>0.05。结论:三维适型放疗同期化疗较序贯治疗能明显提高肿瘤的局控率,改善生存率,毒副反应无明显增加。

OBJECTIVE：To evaluate the efficiency and site effects of the three-dimensional conformal radiation therapy and synchronization NP chemotherapy in locally advanced non-small cell lung cancer. METHODS： Eighty-six cases of locally advanced non-small cell lung cancer were randomly divided into the three-dimensional conformal radiation and synchronization NP chemical therapy （synchronization group, 40 cases） and the three-dimensional conformal radiation and sequence NP chemical therapy （sequence group, 46 cases）. The radiation dose was 64 Gy. The chemical therapy scheme was NVB and DDP （NVB25 mg/m^2, d1,d8; DDP 25 mg/m^2, d1-d3）. The course of treatment was 3 weeks. RESULTS： Eighty-six cases were all completed. The cumulative survival rates in the cynchronization group and the sequencegroup were 85. 0%（34/40） and 76.1%（35/46） respectively, P〈0. 05; 1 year cumulative survival rates were 67. 5% （27/40） and 60. 9% （28/46） respectively, P〈0.05. The inhibition rates of bone marrow stage Ⅲ and Ⅳ were 22.5 % （9/40） and 21.7% （10/46） respectively （P〉0.05）, the rates of stage Ⅱ and Ⅲ of radioactive pneumonia were 10.0% （4/40） and 8. 7% （4/46）, P〉0.05, the stage Ⅱ and m of radioactive esophagitis were 22.5%（9/40） and 19.5% （9/46） respectively,P〉0.05. CONCLUSION： The three-dimensional conformal radiation and synchronization NP chemical therapy obviously increases tumour local control rate and is superior to the three-dimensional conformal radiation and sequence chemical therapy, in greatly improving survival rate, and the poison and side effects are not obviously increased.