小剂量TP方案联合三维适形放疗治疗老年局部晚期非小细胞肺癌的临床观察

Clinical Observation of Low-dose TP Combined with Three-dimensional Conformal Radiation Therapy in the Treatment of Local Advanced Non-small Cell Lung Cancer in Elderly Patients

目的：观察小剂量紫杉醇＋顺铂（TP）方案联合三维适形放疗治疗老年局部晚期非小细胞肺癌（NSCLC）的疗效和安全性。方法：46例老年局部晚期NSCLC患者均给予紫杉醇注射液150 mg/m2,静脉滴注,d1＋顺铂注射液25 mg/m2,静脉滴注,d2-4＋三维适形放疗照射肺部原发灶和肺门、纵膈淋巴结受累区,常规照射2 Gy/次,5次/周,剂量达40 Gy/20次后缩野,避开脊髓继续照射,总量达60～65 Gy/30～33次,有锁骨上淋巴结转移者同时加野放疗。化疗前6、12 h分别给予地塞米松10 mg,口服;化疗前0.5 h给予甲氰咪胍0.4 mg,静脉滴注;化疗前0.5 h给予苯海拉明40 mg,肌肉注射。3周为1个周期,至少2个周期后评价疗效及毒性反应,并随访生存率。结果：所有患者接受至少2个周期的治疗后总有效率为73.9%,疾病控制率为89.1%。主要毒性反应为骨髓抑制,恶心、呕吐,放射性食管炎,放射性肺炎,但患者均可耐受。随访结束后14例生存,生存率为43.8%。结论：小剂量TP方案联合三维适形放疗治疗老年局部晚期NSCLC的疗效较显著,且安全性较好,可提高老年患者生存质量,但其远期疗效有待进一步观察。

OBJECTIVE： To observe therapeutic efficacy and safety of low-dose paclitaxel and cisplatin （TP） scheme com- bined with three-dimensional conformal radiation therapy in the treatment of local advanced non-small cell lung cancer （NSCLC） in elderly patients. METHODS： 46 elderly patients with advanced NSCLC were given Paclitaxel injection 150 mg/m2 intravenously; combined with Cisp!atin injection 25 mg/m2 intravenously d1; three-dimensional conformal radiation therapy d2-4, inadiating pulmonary primary tumor, hilus of lung, mediastinal lymph node involvement area, 2 Gy/time, 5 times a week; reduced field and avoided medulla spinalis after dose reached 40 Gy/20 time; the increase field radiotherapy was conducted in patients with supraclavicular lymphatic metastasis after total dose reached 60-65 Gy/30-33 times. They were given dexamethasone 10 mg orally 6 h and 12 h before chemotherapy, tagamet 0.4 mg intravenously 0.5 h before chemotherapy, and dimedrol 40 mg intramuscularly 0.5 h before chemotherapy. A treatment course lasted for 3 weeks. Therapeutic efficacy and toxic reaction were evaluated and survival rate was fol- lowed up after at least 2 cycles. RESULTS： All patients received 2 cycle of therapy at least. Total response rate was 73.9%, and to- tal disease control rate （DCR） was 89.1%. The main side effects were bone marrow suppression, nausea, vomiting, radiation esophagitis and pneumonitis, which all can be tolerated. After follow-up, there were 14 survival cases with survival rate of 43.8%. CONCLUSIONS： Low dose TP scheme combined with three-dimensional conformal radiation therapy is effective and safe in the treatment of local advanced NSCLC in elderly patients, and can improve the quality of life. Long-term efficacy remains to be seen.