局部进展期非小细胞肺癌同步放化疗+放射性粒子植入治疗初步研究

Primary study of chemoradiotherapy combined with radioactive iodine-125 implantation for locally advanced non-small cell lung cancer

目的初步比较同步放化疗±放射性^125Ⅰ粒子植入治疗局部进展期非小细胞肺癌疗效及不良反应。方法选取2014年3月至2015年3月建湖县人民医院和盐城市三院放疗科收治的38例患者,随机分成观察组(20例,同步放化疗+放射性^125Ⅰ粒子植入治疗)和对照组(18例,同步放化疗)。两组患者均行三维适形常规分割放疗和TC方案化疗。观察组3个月后进行放射性125Ⅰ粒子植入治疗。比较两组患者近期疗效、无进展生存、总生存及不良反应情况。结果观察组、对照组总有效率分别为85%、56%(P=0.046)。随访截至2018年5月,观察组、对照组无进展生存率分别为65%、61%(P=0.457),总生存率分别为32%、26%,中位生存期分别为22.8(95%CI为20.5~23.5)、21.3(95%CI为15.9~26.0)个月(P=0.633)。观察组、对照组不良反应发生率分别为45%、78%(P均>0.05)。结论同步放化疗联合放射性^125Ⅰ粒子植入治疗局部进展期非小细胞肺癌近期疗效显著,对延长远期生存也有一定作用,且严重不良反应发生情况较少,值得进一步扩大样本研究。

Objective To comparatively evaluate the clinical efficacy and adverse events of chemoradiotherapy combined with/without radioactive iodine-125(125-I) implantation for locally advanced non-small cell lung cancer. Methods With locally advanced non-small cell lung cancer admitted to Department of Radiotherapy of Jianhu County People's Hospital and Yancheng Third People's Hospital from March 2014 to March 2015 of 38 patients were enrolled and randomly divided into the observation (chemoradiotherapy+ radioactive 125-I implantation, n=20) and control groups (chemoradiotherapy, n=18). All patients underwent conventional three-dimensional conformal radiotherapy and TC chemotherapy. In the observation group, 125-I implantation was performed at 3 months after chemoradiotherapy. The short-term clinical efficacy, progression-free survival, overall survival and adverse events were statistically compared between two groups. Results The total effective rate in the observation group was 85%, significantly higher than 56% in the control group (P=0.046). Until May, 2018, the progression-free survival rates in the observation and control groups were 65% and 61%(P=0.457), the overall survival rates were 32% and 26%, and the median survival time was 22.8(95%CI: 20.5-23.5) and 21.3(95%CI: 15.9-26.0) months (P=0.633). The incidence rates of adverse events in the observation and control groups were 45% and 78%(P>0.05). Conclusions Concurrent chemoradiotherapy combined with radioactive 125-I implantation yields high short-term efficacy in the treatment of locally advanced non-small cell lung cancer. It can prolong the long-term survival to certain extent and yield a low incidence rate of severe adverse events, which deserves to be validated by large sample-size investigations.