非小细胞肺癌三维适形放疗的临床分析

Clinical study of non-small cell lung cancer using three-dimensional conformal radiotherapy

目的分析3DCRT及联合化疗在非小细胞肺癌治疗中疗效、放射损伤情况和预后情况。方法 63例符合入组标准的Ⅰ～Ⅲ期NSCLC患者纳入本研究,27例为单纯放疗,放疗中单次剂量中位值为2Gy(1.8～4.0Gy),5次/周,中位总剂量65Gy(60～112Gy),95%的PTV得到处方剂量。中位随访期13个月。不进行区域淋巴结预防性照射。CTV照射60Gy(2Gy/次,1次/d,5d/周)后GTV剂量递增,2～5Gy/次,递增次数为3～11次。36例合并化疗,化疗方案以铂类为基础,主要方案包括NP方案和TP方案。结果全组病例完全缓解27.0%(17/63),部分缓解65.1%(41/63),稳定7.9%(5/63),有效率为92.1%;全组1、2年总生存率为57.1%和38.1%,中位生存期14个月。放疗组和放化疗组1、2年生存率分别为50%和15.4%、63.9%和30.6%。中位生存期分别为15个月和11个月,两组比较差异有统计学意义(x2=7.567,P=0.006)。单因素和多因素分析未显示不良因素。结论 3DCRT联合化疗安全有效,两者的联合应用能够提高NSCLC的临床疗效,较单放组有更好的近期疗效,放化疗组在无明显增加放射副反应的基础上,1、2年生存期延长。同步放化疗组放射损伤可耐受,放射治疗剂量有提升空间,值得进一步研究。

Objective To investigate the therapeutic effects of three dimensional conformal radiotherapy （3 DCRT） and 3DCRT combined with chemotherapy for non-small cell lung cancer（NSCLC）.Methods 63 patients who were treated with radiotherapy alone （RT group,27cases） or radiotherapy plus chemotherapy （CRT group,36 cases）were entered into the database for study.The median total dose was 60 Gy.The GTV dose start dose escalation after the CTV irradiated 60 Gy （2 Gy/times,1times/day,and 5 days/week）.The boost fractions were 3-11 times （2 Gy /fraction） and did not conduct regional lymph node preventive irradiation.36 cases combined chemotherapy,chemotherapy with platinum-based and major programs including the NP program and the TP program.Results The complete remission was 27.0（17/63） and partial remission was 65.1%（41/63）.The response rate was 92.1%.1 and 2 year overall survival rates were 57.1%,38.1% respectively.The median survival rate of the entire group was 14 months.The difference of the groups was statistically significant （x 2 =7.567,P= 0.006）.Univariate and multivariate analysis did not show adverse factors.Conclusion 3DCRT joint chemotherapy is safe and effective.Both in combination can improve the clinical efficiency of NSCLC.Compared with radiotherapy alone there was a better sort-term effect,no significant increase on the basis of radiation side effects from the radiotherapy and chemotherapy group and 1 and 2 year prolonged survival rates.Radiation injury can be tolerated.The radiation dose has room for improvement and need further study.