非小细胞肺癌三维适形放射治疗疗效观察

Three-dimensional conformal hypofractionated high-dose radiotherapy combined with chemotherapy for non-small-cell lung cancer

目的 探讨三维适形大分割照射结合化疗治疗非小细胞肺癌 (NSCLC)的疗效。方法 4 3例NSCLC中鳞癌 30例、腺癌 10例、腺鳞癌 3例。全部患者放射治疗前均用健择 (10 0 0mg/m2 第 1、8天 )和顺铂 (30mg/m2 第 1～ 3天 )化疗 3个周期 ,2 1d为一疗程。放射治疗采取肿瘤直径≤ 7cm者 5～7个适形野 ,>7cm者 3～ 4个适形野 ;4 8～ 6 0Gy ,8～ 10分次 ,2 1～ 2 4d完成。锁骨上淋巴结转移的患者用 12MeV的电子线常规分割放射治疗 ,剂量 6 6～ 70Gy ,7周完成。结果 4 3例近期疗效中 ,12例完全缓解 (CR) ,2 2例部分缓解 (PR) ,4例稳定 (NC) ,5例进展 (PD) ,肿瘤总有效 (CR +PR)率为 79.1%(34/ 4 3)。 1、2、3年生存率分别为 75 .2 %、5 3.2 %、35 .4 %。结论 三维适形大分割照射结合化疗治疗NSCLC有较好的疗效 ,更远期疗效尚待进一步观察。

Objective To evaluate the effect of 3-dimensional conformal hypofractionated high-dose radiotherapy combined with chemotherapy on non-small-cell lung cancer (NSCLC). Methods Between July 1998 and October 1999, 43 NSCLC patients, of whom 30 with squamous carcinoma, 10 adenocarcinoma and 3 adenosquamous carcinoma were admitted into our department. They were first treated with chemotherapy by Gemcitabine (1000?mg/m 2, d1,d8) and Cisplatin (30?mg/m 2, d1～3) for 3 cycles, with one cycle lasting 21 days. Then, these patients received radiotherapy with 5-7 conformal fields if tumor≤7?cm and 3-4 conformal fields if tumor>7?cm to a dose of 48-60?Gy in 8-10 fx over 21-24 days. Patients with positive supraclavicular lymph nodes received conventional fractionated radiotherapy with 12 MeV-E to a total dose of 66-70 ?Gy in 7 weeks. Therapeutic effect and survival rate were studied. Results Twelve patients achieved CR, 22 PR, 4 NR and 5 PD, with a total response rate of 79.1%(34/43). The 1-, 2- and 3-year survival rates were 75.2%, 53.2% and 35.4%. Conclusions Three-dimensional conformal hypofractionated high-dose radiotherapy combined with chemotherapy should be considered as an effective and feasible approach in the treatment of NSCLC patients. Long-term survival and possible specific injury await further study.