图像引导大分割调强放疗同步化疗治疗局部晚期非小细胞肺癌的临床研究

An Analysis of Local Advanced Non-small Cell Lung Cancer Treated with Image-guided Hypofractionated Intensity Modulated Radiotherapy combined with Chemotherapy

目的:探讨图像引导大分割调强放疗同步化疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法:2011年8月至2013年4月,44例局部晚期NSCLC患者(ⅢA期20例,ⅢB期24例)行图像引导大分割调强放疗。肺部原发灶计划靶体积总剂量60Gy^72Gy,3Gy^8Gy/次,1次/天,3次~5次/周。患者同步行铂类为基础双药联合方案化疗至少2周期。结果:44例患者,完全缓解(CR)7例,部分缓解(PR)29例,稳定(NC)6例,进展(PD)2例,有效率(RR)81.8%。中位随访时间21个月,1、2年总生存率(OS)和中位生存时间(MST)分别为79.5%、51.3%和25个月。1、2年局部控制率分别为86.4%、59.1%。1、2年无疾病进展生存(PFS)和中位PFS分别为61.2%、38.7%和18个月。3级以上急性放射性肺炎、放射性食道炎发生率分别为6.8%和9.1%。3级以上白细胞、血红蛋白、血小板计数减少率分别为38.6%、6.8%、13.6%。结论:图像引导大分割调强放疗同步化疗治疗局部晚期NSCLC近期疗效和生存率较好,放化疗毒性未见明显增加,耐受性好。

Objective： To observe the efficacy and the toxicity of the image-guided intensity modulated hypofractionated radiotherapy combined with chemotherapy for the treatment of local advanced non-small cell lung cancer（ NSCLC）. Methods： From August 2011 to April 2013,44 patients with local advanced non-small cell lung cancer（ Stage IIIA： 20 pts,Stage IIIB： 24 pts） were treated with image-guided intensity modulated hypofractionated radiotherapy combined with chemotherapy. A total dose of 60 Gy ~ 72 Gy was given to the planning target volume（ PTV） of thoracic primary tumor.Hypofractionated radiotherapy scheme was 3Gy ~ 8Gy / f / d,3 ~ 5f / w. All patients received at least 2 cycles of concurrent platinum-based double medicine combination chemotherapy. Results： The response rate was 81. 8%. A complete response was achieved in 7 patients（ 15. 9%）,and 29 patients（ 65. 9%） achieved a partial response. The 1-,2-year overall survival rate（ OS） and median survival time（ MST） were 79. 5%,51. 3% and 25 months,respectively. The 1-,2-year local control rates（ LCR） were 86. 4% and 59. 1%. The 1-,2-year progression-free survival（ PFS） and median progressionfree survival were 61. 2%,38. 7% and 18 months,respectively. The incidence rates of grade 3＋acute radiation pneumonitis and radiation esophagitis were 6. 8% and 9. 1%. The main chemotherapy-induced acute toxic reactions were bone marrow depression（ grade 3＋） included 17 patients（ 38. 6%） with leukopenia, 3 patients（ 6. 8%） with anemia,6 patients（ 13. 6%） with thrombocytopenia. Conclusion： Image-guided intensity modulated hypofractionated radiotherapy combined with chemotherapy is safe and results in excellent local control and survival for local advanced NSCLC with tolerable toxicity.