诱导化疗联合适形放疗治疗局部晚期非小细胞肺癌23例临床观察

Induction chemotherapy combined with three-dimensional conformal radiation therapy in the treatment of locally advanced non-small cell lung cancer

目的观察诱导化疗联合三维适形放疗治疗局部晚期非小细胞肺癌的临床疗效和毒副反应。方法 23例局部晚期非小细胞肺癌先诱导化疗2-3个周期,而后放疗。其中6例直接适形放疗,4例常规放疗50Gy后适形放疗推量,13例常规放疗60Gy后适形放疗推量,靶区总剂量按BED生物等效公式换算成常规量分别为74-84Gy、76Gy、74-80Gy。结果 23例患者CR4例,PR11例,NR6例,PD2例,总有效率为(CR+PR)65.2%。1、2年总生存率分别为72.7%、41.9%,中位生存期22个月;1、2年无局部进展生存率分别为79.7%、59.8%,中位局部进展时间25个月;1、2年无远处转移生存率分别为78.0%、52.4%,中位远处转移时间21个月;1、2年无进展生存率分别为59.9%、24.9%,中位疾病进展时间17个月。全组病人1例出现3级肺损伤;2例出现3级食道损伤;1例出现3度血小板下降,3例出现3度白细胞下降,1例出现4例白细胞下降。结论诱导化疗联合三维适形放疗治疗非小细胞肺癌的临床疗效满意,毒副反应可以接受。

Objective To observe the efficacy and toxicity of induction chemotherapy combined with three-dimensional radiation therapy（3DCRT）in the treatment of patients with locally advanced non-small cell lung cancer（NSCLC）.Methods 23 patients with locally advanced NSCLC were treated by 2～3 cycles induction chemotherapy followed by 3DCRT,of which 6 cases were directly treated by 3DCRT,4 cases received conventional radiotherapy to a target dose of 50Gy before 3DCRT,13 cases received conventional radiotherapy to a target dose of 60Gy before 3DCRT.The total dose of target（translate into conventional dose by biologic equal formula of BED） was 74-84 Gy,76 Gy and 74-80 Gy respectively.Results Among the 23 patients,4 achieved complete remission,11 partial remission,and the overall response rate was 65.2%.The overall 1-,2-year survival rates was 72.7%,41.9% respectively,the median survival time was 22 months;the 1-,2-locally progress-free survival rates was 79.7%,59.8% respectively,the median time to locally progress was 25 months;the 1-,2-metastasis-free survival rates was 78%,52.4% respectively,the median time to metastasis was 21 months;the 1-,2-progress free survival rates was 59.9%,24.9% respectively,the median time to progress was 17months.There was 1 case experiencing Grade 3 radiation pneumonitis,2 cases experiencing Grade 3 esophagitis;Grade 3 leukopenia occurred in 3 patients,Grade 4 leukopenia occurred in 1 patient and Grade 3 thrombocytopenia occurred in 1 patient.Conclusion It was satisfactory for induction chemotherapy combined with three-dimensional radiation therapy in the treatment of patients with locally advanced NSCLC,with the tolerable toxicity.