同步放化疗治疗局部晚期非小细胞肺癌

Concurrent Radiochemotherapy in the Treatment of Locally Advanced Non-Small Cell Lung Cancer

目的:探讨同步放化疗治疗不能手术的Ⅲ期非小细胞肺癌的疗效及不良反应。方法:分析1998年1月—2007年12月进行同步放化疗的183例不能手术的Ⅲ期非小细胞肺癌患者的临床资料。全组患者均采用常规放疗,每次2Gy,每周5次。在放疗的第1周及第5周各予依托泊苷联合顺铂方案化疗1个周期。结果:179例患者完成了60～70Gy放疗,2例放疗总量52Gy,1例放疗总量54Gy,1例放疗总量56Gy。全组有效率为76.5%,中位疾病进展时间为10.8个月,中位生存期16.3个月,1、2和3年总生存率分别为63.2%、33.2%和21.3%。治疗失败原因为远处转移68例,局部复发18例,局部复发加远处转移19例。不良反应主要为放射性食管炎、放射性肺炎、骨髓抑制,各例均可耐受。结论:同步放化疗治疗局部晚期非小细胞肺癌具有较好的疗效,不良反应可耐受,治疗失败原因主要为远处转移。

Objective：To investigate the efficacy and toxicity of concurrent radiochemotherapy（CRCT） for unresectable stage Ⅲ non small cell lung cancer（NSCLC）. Methods： The data of 183 patients with unresectable stage Ⅲ NSCLC treated with CRCT between January 1998 to December 2007 were reviewed. All patients received conventional radiotherapy （5 fractions per week,one time per day,2 Gy per day） with concurrent chemotherapy （cisplatin and etoposide）.Results： One hundred seventy nine patients received radiotherapy with a total dose of 60470 Gy,2 received 52 Gy,1 received 54 Gy and 1 received 56 Gy. The total response rate was 76.5 %. The median time to progression （TTP） was 10.8 months,and median survival time （MST） was 16.3 months. The overall 1,2,3 year survival rates were 63.2%,33.2% and 21.3%,respectively. The patterns of failure were distant metastasis for 68 cases, local recurrence for 18 cases, and local recurrence plus distant metastasis for 19 cases. The main toxicities were neutropenia, radiation esophagitis and radiation pneumonitis. Conclusions： Concurrent radiochemotherapy is a feasible,well tolerated and active scheme in the treatment of locally advanced NSCLC. The major pattern of failure is distant me tastasis.