诱导化疗后调强适形放疗治疗局部进展期非小细胞肺癌临床结果分析

Retrospective Analysis of Clinical Results of IMRT after Induction Chemotherapy for Locally Advanced NSCLC

目的 回顾分析诱导化疗后调强放疗治疗局部进展期非小细胞肺癌（NSCLC）的临床疗效和放化疗相关不良反应.方法 59例局部进展期（ⅢA和ⅢB期）NSCLC均采用诱导化疗后调强放疗治疗方案,化疗采用顺铂＋紫杉醇方案2周期,3周重复,放疗剂量60 ～ 70.4Gy,1.8 ～ 2.2Gy/次,每周5次.结果 （1）全组患者中位生存时间为19个月,1年总生存率（OS）为81％,2年OS为36％,3年OS为25％.（2）3级急性放射性肺炎发生率为5％（3/59）,3级晚期放射性肺损伤发生率为3％ （2/59）,3级急性放射性食管炎5％（3/59）,3、4级急性血液学毒性为29％（17/59）.结论 诱导化疗后调强适形放疗用于局部进展期NSCLC治疗,患者临床疗效较单纯放疗好,放疗相关性肺炎、食管炎发生率较同步放化疗方案低,适合一般状况较差的老年患者.

Objective To retrospectively analyze clinical efficacy and chemo-radiotherapy-correlated toxicity of locally advanced NSCLC getting induction chemotherapy followed intensity-modulated radiotherapy.Methods Fifty-nine patients with NSCLC （phase Ⅲ A and Ⅲ B） were treated with induction chemotherapy and intensity-modulated radiothedrapy.Induced chemotherapy with cisplatin and taxinol was carried out for 2 circles.The prescription dose was 60-70.4Gy,dose per fraction was 1.8-2.2Gy.Results （1） Median survival period was 19 months.One-year OS was 81％,2-year OS was 36％,and 3-year OS was 25％.（2） The occurrence rate of acute chemoradiation-induced pneumonitis of Grade 3 or higher and pulmonary fibrosis was 5％ （3/59） and 3％ （2/59）,respectively.Acute chemoradiation-induced esophagitis of Grade 3 and Grade3,4 hematotoxicity were 5 ％ （3/59） and29％ （17/59）,respectively.Conclusion IMRT after induction chemotherapy can provide better OS results than radiotherapy alone for locally advanced NSCLC patients.The rate of chemoradiation-induced pneumonitis and esophagitis was lower compared with concurrent chemoradiotherapy.