常规放疗、三维适形放疗联合化疗治疗局部晚期肺癌的疗效比较

The curative effect of General radiotherapy、three-dimensional conformal radio-therapy(3D-CRT)combined with chemotherapy in treatment of locally advanced lung cancer(NSCLC)

目的评价三维适形放疗联合化疗(3D-CRT)治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和急性毒副反应。方法收集2002年4月至2005年12月晚期非小细胞肺癌患者100例,分为三维适形放疗+化疗(A组)50例,常规放疗+化疗(B组)50例。A、B组化疗方案相同,泰素135mg/m2,顺铂70mg/m2,第1、29、57天。A组三维适形放疗放射源为6MV-X线,2Gy/(次·d),40Gy后缩野加量,总剂量DT66～70Gy。B组常规放疗。结果晚期非小细胞肺癌患者经3个月治疗后,Ⅰ、Ⅱ、Ⅲ期CT改变≥50%(11.1%、26.9%、76.9%)与CT改变消失(88.9%、73.3、7.7%),两者比较有显著性差异(χ2=6.70,χ2=6.69,χ2=70.1,P<0.01);鳞癌3年生存率(60.8%)明显高于腺癌(50.0%)两者比较有显著性差异(χ2=4.10,P<0.05);A组有效率(78.0)%明显高于B组(66.0)%(χ2=4.23,P<0.05);A组2年生存率(48.0)%高于高于B组(34.0)%(χ2=4.29,P<0.05);鳞癌有效率(60.0%)高于腺癌(48.4%)(χ2=4.12,P<0.05);放射性肺炎、食道炎、白细胞减少发生率分别为19例(19.0%)、7例(9.0%)、10例(10.0%)。结论3D-CRT联合化疗能提高局部晚期非小细胞肺癌的近期疗效,且急性毒副反应无明显增加。

Objective To evaluate the Short-term effect and acute toxicity by 3D-CRT combined with chemotherapy in patients with NSCLC. Methods From April 2002 to December 2005, 100 patients with advanced non-small cell lung cancer divided into three-dimensional conformal radiotherapy chemotherapy （A group ）50 cases and ordinary radiotherapy chemotherapy（ B group）50 cases. A, B group the same as chemotherapy with Taxal and 3D-CRT simultaneously. Chemotherapy consisted of intravenously Taxal 135 mg/m^2 on days 1,29,57,3 D-CRT was delivered up to a total dose of 66-70Gy with a 2Gy dose fraction perday, 5 days per week. Results The outcome of advanced non-small cell lung cancer patients by 3 months after treatment, Ⅰ , Ⅱ Ⅲ period CT change≥50% （ 11.1% ,26. 9% ,76.9% ） and CT changes in the disappearance （88. 9% , 73.3, 7. 7% ）were significant difference （x^2 = 6.70,x^2 = 6. 69, x^2 =70. 1 ,P 〈0. 01 ） ; squamous cell carcinoma 3- year survival rate （60. 8 % ） than adenoearcinoma （50. 0% ） were significant difference （x^2= 4. 10, P 〈 0. 05 ） ; A group efficiency （ 78.0 ） % significantly higher than that of B group （ 66. 0 ） % （x^2 = 4. 23, P 〈 0.05） ;A group of 2-year survival rate（48. 0% ）higher than Group B（34. 0% ） （x^2 =4. 29 ,P 〈0. 05） ;efficient squamous cell carcinoma（60.0% ） higher than adeno- carcinoma（ 48.4% ） （Xz = 4. 12, P 〈 0. 05 ） ;The incidence of radioactive pneumonia, esophagitis, interleukin reduce were 19 cases （ 19.0% ） ,7 cases （9. 0% ） , 6. 25% ,10 cases（ 10.0% ）. Conclusions The Short-term effect and acute toxicity can improve by 3D-CRT combined with chemotherapy in patients with NSCLC.