非小细胞肺癌多西他赛联合顺铂同步放疗的临床观察

Curative effect observation of Docetaxel combined with Cisplatin plus concurrent three-dimensional conformal radiotherapy for locally advanced non-small cell lung cancer

目的:观察多西他赛联合顺铂同步三维适形放疗(3D-CRT)治疗局部晚期非小细胞肺癌(NSCLC)的疗效与安全性。方法:选择40例(ⅢA期21例,ⅢB期19例)局部晚期NSCLC患者入组,其中39例完成放化疗,多西他赛60mg/m2,静脉滴入,d1;顺铂25mg/m2,静脉滴入,d1～d3;21d为1个周期,共3个周期,同步放化疗后巩固2个周期。化疗第1天行3D-CRT,DT66Gy/(33f·45d)。靶区采用累积野照射,V20<35%。结果:39例中CR 4例(10.3%,PR26例(66.7%),SD 7例(17.9%),PD 2例(5.1%),总有效率(RR)为76.9%(30/39),1、2年总生存率和局部控制率分别为83.0%、39.0%和94.9%(37/39),鳞癌和腺癌的有效率分别为80.9%(17/21)和76.9%(10/13),差异无统计学意义,P=0.777 7。不良反应主要表现为血液学毒性,出现Ⅲ或Ⅳ度白细胞减少、贫血和血小板减少的患者分别为7例(17.9%)、3例(7.7%)和2例(5.1%);非血液毒性反应较轻,主要表现为胃肠道反应、放射性食管炎等。上述不良反应给予对症处理后均可恢复,无治疗相关死亡事件的发生。1例因白细胞Ⅳ度抑制退出组。结论:多西他赛联合顺铂同步3D-CRT治疗局部晚期NSCLC近期及远期疗效均较好,不良反应低。

OBJECTIVE：To observe the curative effect and security of Doeetaxel combined with Cisplatin and concurrent three-dimensional eonformal radiotherapy （3DCRT） for locally advanced non-small cell lung cancer （NSCLC）. METHODS： There were 40 cases （Ⅲ A 21 cases, Ⅲ B 19 cases） of locally adanced NSCLC patients entering the group,among which thirty nine patients underwent chemoradiation, Docetaxel 60 mg/m^2 , d1 , intravenous drip,Cisplatin 25 mg/m^2 d1 - d3, intravenous drip ; 21 day for a eycle,a total of three cycles, the chemoradiation consolidate after 2 cycle. The first day of chemotherapy was 3D-CRT, DT 66 Gy/（33 f· 45 d）. Accumulated irradiation was used for target area,V20〈35%. RESULIS： Four of the 39 cases were corn plete remission CR （ 10.3 % ）, 26 cases were PR （66.7% ）, 7 cases were SD （ 17.9 %）, 2 cases are PD （5. 1 %）, the total effective rate （RR） was 76.9%. The 1 and 2 years overall survival rate （OS） and local control was 83.0% ,39.0% and 94.9%（37/39）. There was no significant difference for the effective rate of squamous carcinoma（80.9 % （17/21）-3 and adenoearcinomat[76.9 （10/13） ,P=0. 777 7]. The toxic side-effect mainly was hematology toxicity,and the cases with Ⅲ/Ⅳ degree leukopenia,anemia, and thrombocytopenia were in 7 cases （17.9 % ） ,3 cases （7.7% ） and 2 cases （.5.1% ） respectively. All the adverse react~ mentioned above could be restored after symptomatic treatment, and there was no therapy related death. One case quit out the group he cause of Ⅳ degree leukocyte inhibitory. CONCLUSIONS： The treatment of Docetaxel combined with Cisplatin and concurrent 3D-CRT for locally advanced NSCLC have good short term and long term curative effect with tolerable toxicity.