非小细胞肺癌调强放化疗的近期疗效观察

Observation of short-term effect for intensity modulated radiotherapy and chemotherapy in non-small cell lung cancer

目的:分析调强放疗(IMRT)联合化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应。方法:48例局部晚期不能手术或不愿手术的NSCLC患者,采用IMRT同步联合化疗综合治疗。放疗采用5～7野IMRT技术,单次剂量2.0～2.2Gy,每周5次,中位总剂量60Gy(54～66Gy)。所有患者均接受2个周期长春瑞滨加顺铂方案同步化疗,放疗结束后辅助2～4个周期化疗。结果:所有患者均顺利完成同步放化疗计划。放疗结束3个月后评价疗效,CR为21%(10/48),PR为60%(29/48),SD为13%(6/48),PD为6%(3/48),有效率为81%(39/48)。中位随访时间为11个月(7～30个月),中位生存时间为25个月,1和2年总生存率分别为73%和39%。按RTOG标准评价放疗毒副反应,放射性食管炎Ⅰ级15例,Ⅱ级11例,Ⅲ级1例;放射性气管炎Ⅰ级14例,Ⅱ级8例,Ⅲ级3例;放射性肺炎Ⅰ级6例,Ⅱ级4例,Ⅲ级1例。结论:IMRT联合化疗对局部晚期NSCLC患者有较好的疗效,毒副反应可以被绝大多数患者耐受,对生存率的提高有待进一步研究。

OBJECTIVE： To investigate the recent therapeutic effect and adverse effect of the intensity-modulated radiotherapy （IMRT） plus chemotherapy for the locally advanced non-small cell lung cancer （NSCLC）. METHODS： Total of 48 patients of locally advanced NSCLC, who was unresectable or unwill to receive surgery, receiving the IMRT and chemotherapy were recruited. Radiation was performed with 5--7 fields IMRT, 2.0--2.2 Gy per fraction and 5 fractions per week. The median dose was 60 Gy （54--66 Gy）. All patients received two cycles of concurrent chemotherapy with vinorelbine and cisplatin regimens,and followed by 2 4 cycles of consolidate chemotherapy. RESULTS： All patients completed this treatment schedule. The short-term therapeutic effect after three months of the radiotherapy. Complete remission 21% （ 10/48）, partial remision 60 % （29/48）, stable disease 13 % （6/48）, and progressive disease 6 % （3/48）, therefore the effective rate was 81%（39/48）. With an median follow up of 11 months （7--30 months）,the median survival time was 25 months, 1-year and 2-year overall survival rate was 73 % and 39 %, respectively. According to RTOG criteria, the acute adverse effect were：radiation esophagitis, Ⅰ grade 15 patients, Ⅱ for 11, Ⅲ for 1;radiation bronchitis, Ⅰ for 14 pa tients, Ⅱ for 8, Ⅲ for 3 ; radiation pneumonitis, Ⅰ for 6 patients, Ⅱ for 4 and Ⅲ for 1 patients. CONCLUSION ： IMRT plus chemotherapy is effective for locally advanced NSCLC with less side effects and well tolerated approach, further studies needed to improve the overall survival rate.