三维适形放疗同步奥沙利铂化疗治疗不可手术Ⅲ期非小细胞肺癌的临床研究

Research of three-dimensional conformal radiotherapy combined with concurrent weekly oxaliplatin for inoperable stage Ⅲ non-small cell lung cancer

目的 探讨三维适形放疗同步每周小剂量奥沙利铂化疗治疗不可手术Ⅲ期非小细胞肺癌（NSCLC）的疗效、毒副反应以及生存期.方法 将64例不可手术的Ⅲ期NSCLC患者分为诱导化疗后胸部三维适形放疗（3D-CRT）同步小剂量奥沙利铂化疗组（同步组）32例和诱导化疗后胸部三维适形放疗组（序贯组）32例.两组均采用以铂类为基础的化疗方案先诱导化疗2周期,获疾病控制者（CR＋PR＋SD）休息3～4周开始胸部三维适形放疗,同步组在放疗的同期给予小剂量奥沙利铂（50mg/次）化疗,每周1次,直至放疗结束.两组胸部放疗总剂量相同均为66Gy/33f,每周一至周五.两组放疗结束后获疾病控制者休息4～6周后进一步行多西他赛或吉西他滨单药巩固化疗2周期.结果 中位随访13.5个月,同步组和序贯组的中位总生存期（OS）分别为17.0个月和14.5个月,中位无进展生存期（PFS）分别为12.9个月和9.2个月,1年和2年生存率分别为62.5%、56.3%和28.1%、21.9%,1年和2年无进展生存率分别为40.6%、31.3%和15.6%、12.5%.毒副反应同步组的2～3级放射性食管炎发生率高（P＜0.05）,其他治疗相关毒性两组比较无统计学差异（P＞0.05）.结论 诱导化疗后胸部3D-CRT同步每周小剂量奥沙利铂化疗治疗不可手术Ⅲ期NSCLC安全有效,毒性反应轻,患者耐受性好.

Objective To evaluate the toxicity and efficacy of three-dimensional conformal radiotherapy （3D-CRT） combined with oxaliplatin on inoperable stage m non-small cell lung cancer（NSCLC） patients. Methods Sixty-four inoperable NSCLC patients were divided into induction chemotherapy followed by concurrent weekly low-dose oxaliplatin and radiotherapy group （group A） or sequential chemoradiotherapy group （group B）. The group A were treated with inductive cisplatin （70mg/m^2 dj-d3 ） basement chemotherapy （combined with vinorelbine 25mg/m^2 d1 ,ds or pacilitaxel 175mg/m^2 d1 or gemeitabine 1000mg/m^2 d1,d8 or docetaxel 75mg/ m^2 d1 ） for two cycles（21 days was a cycle） and followed by concurrent chemoradiotherapy （ oxaliplatin 50mg weekly for 7 weeks）. The following consolidation chemotherapy was consisted of two cycles of docetaxel （75mg/m^2 d1 ） or gemeitabine （1000mg/m^2 d1 ）. The group B were treated with the same inductive chemotherapy for two cycles （42 days） ; the following procedures of the therapy were same also with group A except oxaliplatin. All patients were received with the same radiotherapy （66 Gy at 2Gy per fraction, five fractions per week in both two groups）. The patients were followed-up on one month, three months. Results The median follow-up time was 13.5 months （range 2-39 months）. The median overall survival （OS） time was 17.0 months in group A and 14. 5 months in group B. The progression free survival （PFS） time was 12. 9 months in group A and 9. 2 months in group B. The 1- , 2-year overall survival rates were 62. 5% , 56. 3% and 28.1% , 21.9% , respectively. The 1- and 2-year progression free survival （PFS） rates were 40. 6% , 31.3% and 15.6%, 12. 5%, respectively. The major treatment related toxicities included radiation-lnduced esophagitis, radiation pneumonitis, and haematological toxicities. None of them were observed grade 4 either radiation-induced pneumonitis or esophagitis. The incidence rate of grade 3 to 4 neutropenia was 28% （group A） and 15.6% （group B） respectively （P 〉 0. 05 ）. The rate of grade 2 to 3 esophagitis was 37.5% and 12. 5%, respectively （P 〈 0. 05）. There was no death due to the treatment. Conclusion It is safe and efficient that the combination treatment of schedule of 3D-CRT combined with concurrent weekly low-dose oxaliplatin for inoperable stage H1 NSCLC patient,and the therapeutic effects is tended to be superior to sequential demonstration.