长春瑞滨加卡铂同期高剂量放射治疗非小细胞肺癌临床研究

Clinical study of vinorelbine plus carboplatin with concurrent high-dose radiotherapy for non-small cell lung cancer

目的评价长春瑞滨加卡铂(NC)联合同期高剂量70 Gy的三维适形放射治疗非小细胞肺癌的耐受性,并初步观察其疗效。方法病理或细胞学确诊的晚期非小细胞肺癌接受同期放化疗。均采用三维适型放射治疗,常规分割照射,2 Gy/f,1 f/d,5 f/周,总剂量70 Gy,每例患者放疗计划均满足:双肺V20≤30%且V30≤20%。放疗第一天开始长春瑞滨联合卡铂(NC)方案化疗:NVB 25mg/m2,d1,d8,CBP,AUC=5 mg/ml.m2,d8,每28 d重复,同期化疗两周期,放疗结束后最多4周期。结果 37例患者成为研究对象。血液学毒性为86.5%(32/37),Ⅲ/Ⅳ级中性粒细胞减少为18.9%(7/37),Ⅲ/Ⅳ级血小板减少为8.1%(3/37),无Ⅲ级及以上贫血发生。非血液学毒性:Ⅲ级放射性肺炎8.1%(3/37),Ⅲ级放射性食管炎13.5%(5/37),全组无Ⅳ/Ⅴ级非血液学毒性发生。全组完全缓解率(CR)为13.5%(5/37),部分缓解率(PR)64.9%(24/37),近期有效率为(CR+PR)78.4%(29/37)。中位生存期为12.0个月,1年总生存率为45.1%。结论在V20≤30%和V30≤22%的情况下,长春瑞滨加卡铂联合同期70 Gy的三维适型放射治疗非小细胞肺癌可以耐受,有较好的近期有效率、中位生存期和1年总生存率,其远期疗效值得进一步研究。

Objective To evaluate the tolerance of vinorelbine plus carboplatin with concurrent high-dose three-dimensional conformal radiotherapy-70 Gy in treatment of non-small cell lung cancer,and observe its preliminary efficacy.Methods Patients with advanced non-small cell lung cancer proven pathologically or cytologically received concurrent chemoradiotherapy.All cases were treated with three-dimensional conformal radiotherapy with conventional fractionation： 2 Gy/fraction,1fraction/day,5 fractions/week,and total dose was 70 Gy.The radiotherapy plan of every case must meet the following conditions： the percentage of total lung volume receiving 20Gy（V20） was ≤30% and the percentage of total lung volume receiving 30 Gy（V30） was ≤20%.Chemotherapy was started on the first day of radiotherapy.The regimen（NC） of vinorelbine（NVB） plus carboplatin（CBP） was as follows： NVB 25 mg/m^2,d1,d8,CBP,AUC=5 mg/（ml·m^2）,d8,repeated every 28 days,concurrent chemotherapy was given for two cycles during radiotherapy and not more than 4 cycles after radiotherapy.Results Thirty-seven patients were recruited.The hematological toxicity rate was 86.5%（32/37）,grade-Ⅲ/Ⅳ neutropenia rate was 18.9%（7/37）,grade-Ⅲ/Ⅳ thrombocytopenia rate was 8.1%（3/37）,and there was no grade-Ⅲ/Ⅳ anemia.Non-hematological toxicity was as follows： grade-Ⅲ radiation pneumonia rate was 8.1%（3/37）,grade-Ⅲ radiation esophagitis rate was 13.5%（5/37）,and there was no grade-Ⅳ/Ⅴ non-hematological toxicity.The complete response rate（CR） was 13.5%（5/37） and the partial response rate（PR） was 64.9%（24/37）.The total response rate was（CR＋PR） 78.4%（29/37）.The median survival time was 12.0 months and overall 1-year survival rate was 45.1%.Conclusions Under the condition of V20≤30% and V30≤20%,vinorelbine plus carboplatin with concurrent 70Gy three-dimensional conformal radiotherapy was tolerated in the treatment of NSCLC.This concurrent chemoradiotherapy regimen achieved good total response rate,median survival time and 1-year overall survival rate.The long-term efficacy of this regimen was worthy further evaluation.