体部伽玛刀序贯TP方案治疗老年局部晚期非小细胞肺癌的临床观察

Body-gamma knife sequential TP regimen for elderly patients with locally advanced non-small cell lung cancer

目的观察体部伽玛刀序贯TP方案(多西他赛+卡铂)治疗老年局部晚期非小细胞肺癌(NSCLC)的临床疗效及毒副反应。方法 60例70岁以上患者均采用体部伽玛刀放疗,50%～60%处方剂量线,4～6Gy/次,每周3～5次,总剂量36～50Gy,生物等效剂量56～75Gy。体部伽玛刀治疗结束后1～2周序贯TP方案化疗,具体为:多西他赛75mg/m2静滴,d1;卡铂300mg/m2静滴,d1,21～28天为1周期,共化疗2～4周期。化疗结束后1个月评价疗效。结果 60例患者均完成治疗,总有效率为95.0%。1、2、3年生存率分别为86.7%、52.4%和28.3%。急性放射性肺炎发生率为16.7%,急性放射性食管炎发生率为8.3%,白细胞减少发生率为75.0%,恶心呕吐发生率为20.0%,均为1～2级。结论体部伽玛刀序贯TP方案治疗老年局部晚期NSCLC患者的疗效好,毒副反应轻,值得临床进一步研究。

Objective To evaluate the clinical efficacy and toxicity of body-gamma knife sequential TP regimen for treatment of elderly patients with locally advanced non-small cell lung cancer（NSCLC）. Methods Sixty elderly patients with locally advanced NSCLC were treated by body-gamma knife radiotherapy： total dose from 36 to 50Gy,biological effective dose（BED）56-75 Gy,4-6Gy/fraction（50%-60% dosage curve）,3-5fractions/week.TP regimen（docetaxel 75 mg/m2 iv dl,carboplatin 300mg/m2 iv d1,3-4 weeks was a cycle） followed 1-2 weeks after body-gamma knife therapy.Each patient should complete no less than two cycles＇ chemotherapy.The response and toxicity were evaluated and survival rate was followed up. Results The total response rate was 95.0%.The 1-,2-and 3-year survival rate was 86.7%,52.4% and 28.3%.The main toxicities were local radiation pneumonia（16.7%）,radiation esophagitis（8.3%）,leucopenia（75.0%）,and nausea/vomiting（20.0%）,mainly grade 1-2. Conclusion Body-gamma knife sequential TP regimen for elderly patients with locally advanced NSCLC is effective.The toxicities are mild.It is worthy of further study.