吉非替尼联合立体定向放疗一线治疗高龄非小细胞肺癌的临床观察

Clinical observation on gefitinib combined with γ-ray stereotactic radiotherapy as first-line regimen for treatment of senile patients with non-small cell lung cancer

目的探讨吉非替尼联合立体定向放疗一线治疗高龄非小细胞肺癌的疗效和安全性。方法84例高龄非小细胞肺癌患者按治疗方法分为4组:A组25例,吉非替尼联合立体定向放射治疗;B组32例,单用立体定向放射治疗;C组12例,单用吉非替尼治疗;D组15例,对症治疗。吉非替尼均采用治疗第1天开始口服,每日250mg,直到病变进展或其他原因停药。立体定向放射治疗均从治疗第1天开始,等剂量曲线为50%～80%,单次周边剂量4.0～6.5Gy,治疗总剂量为36～48Gy,治疗次数8～12次,6次/周。结果2个月CT复查肿瘤病灶,A组肿瘤病灶治疗有效率(RR)为68.0%(17/25),疾病控制率(DCR)为92.0%(23/25),中位生存时间(MST)为11.8个月(范围3～21个月),1年生存率为48.0%(12/25),治疗期间常见副反应为皮疹、腹泻;B组RR为56.3%(18/32),DCR为84.4%(27/32),MST为7.2个月(范围3～16个月),1年生存率为12.5%(4/32);C组RR为33.3%(4/12),DCR为58.3%(7/12),MST为8.9个月(范围2～18+个月),1年生存率为33.3%(4/12),治疗期间常见副反应为皮疹、腹泻;D组MST为4.8个月(范围2～10个月),1年生存率为0。吉非替尼联合立体定向放射治疗组在近期疗效(RR及DCR)方面高于单用吉非替尼治疗组(P=0.046,P=0.014),在远期疗效(1年生存率)方面高于单用立体定向放射治疗组(P=0.003)。结论吉非替尼联合立体定向放疗一线治疗高龄非小细胞肺癌具有较好的近期及远期疗效,毒性可耐受。

Objective To evaluate the efficacy and safety of gefitinib combined with -y-ray stereotactic radiotherapy as first-line regimen for treatment of senile patients with non-small cell lung cancer. Methods Eighty-four senile patients with non-small cell lung cancer were divided into 4 groups according to the therapy methods. Group A included 25 patients treated with gefitinib combined with γ-ray stereotactic radiotherapy. Group B included 32 patients treated with γ-ray stereotactic radiotherapy. Group C included 12 patients treated with gefitinib. Group D included 15 patients treated with palliative therapy. The patients received gefitinib 250mg/d from the first day until disease progression or discontinuation due to other reasons. γ-Ray stereotactic radiotherapy began from the first day, the isodose curve was 50%-80%, one dose （fraction） was 4. 0-6. 5 Gy , 6 fractions per week and 8-12 fractions were given, with a total dose of 36-48 Gy. Results CT reexamination of the tumor was carried out 2 months later. In group A, the tumor response rate （RR） was 68.0% （ 17/25 ）, disease control rate （DCR） was 92. 0% （23/25）, the median survival time （MST） was 11.8 months （range 3-21 months ）, the overall 1-year survival rate was 48.0% （12/25）and the main side effects included skin rash and diarrhea. In group B, the RR was 56. 3% （18/32） , DCR was 84. 4% （27/32）, MST was 7.2 months （range 3-16 months） and the overall 1-year survival rate was 12. 5% （4/32）. In group C, the RR was 33.3% （4/12）, DCR was 58.3% （7/12）, and MST was 8. 9 months （range 2-18＋ months ）, the overall 1-years survival rate was 33.3% （4/12） and the main side effects included skin rash and diarrhea. In group D, the MST was 4. 8 months （range 2-10 months ） and the overall 1-year survival rate was 0. The short-term therapeutic effects （ RR and DCT） of group A was higher than group C （P = 0. 046, P = 0. 014）. The long-term therapeutic effects （overall 1-year survival rate） was higher than group B （P = 0. 003 ）. Conclusion Gefitinib combined with γ-ray stereotactic radiotherapy is feasible and effective for treatment of senile patients with non-small cell lung cancer as first-line regimen.