三维适形放疗联合支气管动脉灌注化疗治疗局部晚期非小细胞肺癌的疗效观察

Effect observation of three-dimensional conformal radiotherapy( 3DCRT) combined with bronchial arteries perfusion chemotherapy in the treatment of locally advanced non-small cell lung cancer

目的探讨三维适形放疗联合支气管动脉灌注化疗治疗局部晚期非小细胞肺癌的临床效果。方法对60例诊断明确的局部晚期非小细胞肺癌患者先行支气管动脉灌注化疗:盐酸吉西他滨1000mg/m2,奈达铂50mg/m2;1周后复查血常规,指标正常即开始行三维适形放疗DT:46GY/23f^50GY/25f;1个月后行第2次BAI,方案同前;后再次行CT定位,根据肿瘤缩小情况,调整放疗计划,给予缩野后肿瘤局部二程加量放疗20GY/10f^24GY/12f。2次计划放疗均按照单次计量2GY,每周5次进行。放疗总剂量至60~70Gy/30~35f/6~7周。结果放疗结束1个月后评价疗效,CR13例(21.6%),PR37例(61.6%),SD 7例(11.6%),PD3例(5%)。总有效率CR+PR为83.3%,1年及2年生存率分别为77.1%(44/57)、26.3%(15/57)。结论三维适形放疗二程加量联合支气管动脉灌注化疗治疗局部晚期非小细胞肺癌近期疗效较好,明显提高生存率,未增加放疗不良反应,是目前治疗局部晚期非小细胞肺癌安全有效的治疗方法。

Objective To investigate the clinical effect of three-dimensional conformal radiotherapy （3DCRT） combined with bronchial arteries perfusion chemotherapy in the treatment of locally advanced non-small cell lung cancer. Methods 60 cases of patients with a diagnosis of locally advanced non-small cell lung cancer were treated with bronchial arteries perfusion chemotherapy followed by 3 DCRT. The chemotherapy included gemcitabine hydrochloride 1000mg/m2, nedaplatin 50mg/ m2. One week after the chemotherapy,all patients received the 3DCRT,46 - 50Gy in 23- 25 fractions to PTV. Then the patients were treated by the same bronchial arteries perfusion chemotherapy again one month after the 3DCRT. When the second chemotherapy was ended,patients were treated by 3DCRT again,20 -24Gy/10 - 12f to the GTV. The total dose to the gross tumor volume was 60-70Gy in 30 - 35 fractions,2Gy in 1 fraction,5 fractions every week. Results After one month of the treatment,the CR,PR,SD and PR were 13 patients （21.6%） ,37 patients （61.6%） ,7 patients （11.6%） ,3 patients （5%） respectively. The rate of CR ＋ PR was 83.3%. The 1-year and 2-year survival rate were 77.1% （44/57） and 26.3 （15/57）. Conclusion The combination of 3DCRT with bronchial arteries perfusion chemotherapy is effective in the treatment of locally advanced non-small cell lung cancer, and obviously increases the survival rate, without increasing radiotherapy adverse reactions, is safe and effective treatment.