超分割放疗治疗局部晚期非小细胞肺癌临床研究

Clinical observation on hyperfractionated radiotherapy in the treatment of locally advanced non-small cell lung cancer

目的 观察同期超分割放射治疗联合化疗对局部晚期非小细胞肺癌的临床疗效和毒性反应.方法 对初治局部晚期非小细胞肺癌患者48例分别采用超分割同步放化疗（实验组）或常规分割同步放化疗（对照组）治疗.实验组患者24例,放疗剂量：56～ 64.4 Gy/40～ 46次,1.4 Gy/次,2次/d；对照组患者24例,放疗剂量：60～66 Gy/30～ 33次,2 Gy/次,1次/d.两组患者均接受依托泊苷＋顺铂（EP）方案同步化疗.采用RTOG标准评价急性放射性食管炎发生情况.结果 随访1年,实验组患者1年局部控制率（66.7％）高于对照组（54.2％）（P＜0.05）；1年总生存率（OS）实验组患者（70.8％）高于对照组（58.3％）（P＞0.05）,实验组患者≥2级和≥3级急性放射性食管炎发生率高于对照组（P＜0.05）.结论 局部晚期非小细胞肺癌同期超分割3DRT放化疗联合辅助化疗可获得较理想的局部区域控制率和总生存率；主要毒性反应为急性放射性食管炎、骨髓抑制、消化道反应.

Objective To observe the clinical effect and toxic reaction of hyperfractionated radiotherapy combined with chemotherapy on locally advanced non-small cell lung cancer. Methods Forty-eight patients with locally advanced non-small cell lung cancer who receiving initial treatment were randomly divided into experimental group （ n = 24） and control group （ n = 24）. The patients in experimental group received hyperfractionated radiotherapy and chemotherapy （the dosage of radiotherapy was 56 - 64.4Gy/40 - 46times, 1.4Gy per time, twice a day）, while patients in control group were treated with routine fractionated radiotherapy and chemotherapy （ the dosage of radiotherapy was 60 - 66Gy/30 - 33times, 2Gy per time, once a day）. All patients in the two groups received Etoposide ＋ Platinol （EP） at the same time. RTOG standards was used to assess the acute radiation esophagitis. Results the patients＇have been followed up one year. one-year control rate in experimental group and control group were 66.67% and 54.17%, respectively（ P 〈 0.05） ; the overall survival （OS） rate of one year was 70.83% in experimental group and 58.33% in control group（ P 〉 0.05 ） ; the rates of acute radiation esophagitis （ ≥ Grade 2 and≥ Grade 3 ） in experimental group was higher than that in the control group（ P 〈 0.05 ）. Conclusions Hyperfractionated concurrent 3D radiotherapy combined with chemotherapy increased both local control rate and overall survival rate of locally advanced non-small cell lung cancer. The toxic reaction includes acute radiation esophagitis, digestive tract reaction and hematologic toxic reaction.