甘氨双唑钠联合同步放化疗治疗非小细胞肺癌合并肺不张患者的临床观察

Clinical observation of sodium glyci-didazole combined with concurrent radiochemotherapy for non-small cell lung cancer with atelectasis

目的观察甘氨双唑钠(CM-Na)联合同步放化疗治疗非小细胞肺癌(NSCLC)合并肺不张患者的增敏疗效及不良反应。方法将90例初诊为NSCLC患者按随机分组原则分为增敏组和对照组,每组45例。对照组采用调强放疗(IMRT)+化疗,放疗总剂量DT60~70Gy;鳞癌患者化疗采用紫杉醇+奈达铂(TP)方案,腺癌患者化疗采用培美曲塞+顺铂(PP)方案。增敏组在同步放化疗的基础上予甘氨双唑钠800mg/m2,30min内经静脉滴注完,在60min内行放疗,每周1、3、5给药,至放疗结束。记录2组患者肺复张需重新定位CT时的照射剂量与患者例数,并比较2组治疗后原发灶退缩情况、纵隔淋巴结退缩情况及不良反应。结果增敏组和对照组在放疗过程中因为肺复张需要重新进行CT定位时的患者分别为44例、36例,放疗中位剂量分别为36.16Gy、47.04Gy,2组比较差异具有统计学意义(P<0.05)。增敏组和对照组患者治疗结束时近期有效率分别为97.8%、86.6%,纵隔淋巴结近期退缩有效率分别为100.0%、91.1%,2组比较差异有统计学意义(P<0.05)。2组放射性肺炎等不良反应发生率比较差异无统计学意义(P>0.05)。结论甘氨双唑钠联合同步放化疗能提高NSCLC合并肺不张患者的近期疗效,同时不增加不良反应,但是远期疗效及不良反应还需进一步随访观察。

Objective To observe sensitivity and side-effect of sodium glyci-didazole( CM-Na) combined with concurrent radiochemotherapy for non-small cell lung cancer( NSCLC) with atelectasis. Methods 90 cases of new diagnosed NSCLC patients were randomly divided into sensitizer group and control group,45 cases in each group. The control group took intensity-modulated radiotherapy( IMRT) + chemotherapy. Total dosage of radiotherapy DT: 60 ~ 70Gy; chemotherapy regimen was taxol and Nedaplatin( TP) in patients with squamous carcinoma,chemotherapy regimen was pemetrexed and cisplatin( PP) in patients with adenocarcinoma. Additionally,the sensitizer group was treated with CM-Na( 800mg/m2 intravenous infusion with in 30 min,after which radiotherapy was administered within 60 min on Monday,Wednesday and Friday everyweek till the end of the radiotherapy). The exposure dose and the number of patients in the 2 groups were recorded when the CT was re located,After treatment,the primary tumor regression,mediastinal lymph node withdrawal and adverse reactions between the two groups were compared. Results The number of patients in the sensitizer group and the control group respectively were 44 and 36 when it is need to CT scan simulation again in the course of radiotherapy because of lung recruitment,the median radiation dose were 36. 16 Gy and 47. 04 Gy respectively,the two groups were statistically significant differences( P < 0. 05). For primary lesion,the total effective rate( CR + PR) in sensitizer group and in control group were 97. 8% and 86. 6% respectively,and the CR + PR of mediastium metastatic lesion in the two groups were 100. 0% and 91. 1% respectively,the differences were statistically significant between the two groups( P < 0. 05). There were no significante difference in toxicity like radiation pneumonitis in the two groups. Conclusion CM-Na combined with concurrent radiochemotheraphy for NSCLC with atelectasis increase the short-term therapeutic response without obvious toxicity,but long-term efficacy and toxicity also need further followup observation.