调强放疗联合吉西他滨加顺铂治疗局部晚期非小细胞肺癌临床观察

Intensity-modulated radiotherapy combined with gemcitabine and cisplatin chemotherapy for local advanced non-small cell lung cancer

目的观察调强放射治疗联合吉西他滨、顺铂同步化疗治疗局部晚期非小细胞肺癌疗效与安全性。方法回顾分析2012年1月至2014年6月在我院肿瘤科行调强放疗的45例局部晚期NSCLC患者。给予调强放疗，处方剂量为PTV50．4Gy／28次，常规分割，同步GTV推量，PTV—GTV为60Gy／28次。同步给予化疗，方案为吉西他滨加顺铂，方案为放疗第1d起开始化疗，吉西他滨1．0g／m^2，d1、d8，顺铂25mg／m^2，d1-3，每21d重复。放疗后再采用该方案化疗4个周期。主要观察指标为总有效率（ORB）、毒副反应。结果所有患者按计划完成治疗。近期疗效CR6例，PR 26例，SD 12例，PD 1例。ORR 71．1％。毒副反应主要为恶心、呕吐、骨髓抑制，放射性食管炎，放射性肺炎。结论调强放疗联合吉西他滨加顺铂同步化疗治疗局部晚期NSCLC近期疗效好，毒副反应可耐受，长期疗效有待进一步随访研究。

Objective To evaluate the clinical efficacy and toxicities of intensity-modulated radiotherapy（IMRT） combined with gemcitabine and cisplatin chemotherapy for patients with locally advanced non-smalt cell lung cancer（NSCLC）.Method Forty five patients with NSCLC who received IMRT from January, 2012 to June, 2014 in our hospital were retrospectively analyzed. The IMRT plans were designed to deliver 50.4G y/28 f to PTV while delivering 60 Gy/28 f to GTV. Chemotherapy was given from the first day of IMRT, with gemcitabine 1.0 g/m^2 on day 1 to day 8 and cisplatin 25 my/m^2 on day 1 to day 3. The chemothtrapy was repeated every 21 days, with a total of 4 cycles. The endpoints were overall response rate（ORR） and adverse events. Results All patients completed definitive IMRT and chemotherapy. Complete response（CR）, partial response（PR）, stable disease（SD）, and progressive disease（PD）were observed in 6, 26, 12, and 1 cases, respectively, with a ORR of 71.1%. The main toxicities were tolerable, which included myelosuppression, nausea, vomiting, acute radiation pneumonia, and acute radiation esophagitis. Conclusions IMRT combined gemcitabine and cisplatin themotherapy is efective and safe for most patients with stage Ⅲ non-small cell lung cancer, Long term results needs further follow-up.