立体定向放疗序贯吉西他滨治疗老年局部晚期肺癌的临床观察

目的 评价立体定向放疗序贯吉西他滨治疗老年非小细胞肺癌的疗效.方法 对46例大于70岁老年局部晚期肺癌患者,予以体部γ刀立体定向放疗,应用真空负压袋固定体位、慢速CT定位扫描和三维治疗计划,行立体定向放疗后3～4周予以吉西他滨化疗4周期.中位随访时间为18个月.结果 46例患者完成了立体定向放疗,44例完成吉西他滨单药化疗4周期,2例患者由于4度血小板毒性行2周期化疗后停止.完全缓解2例（4.4%）,部分缓解30例（65.2%）,稳定8例（17.4%）,进展6例（13.0%）.治疗后中位疾病进展时间为7.7个月,全组中位生存期12.6个月.1年总生存率为56%.3度以上放射性肺炎0例,3度以上放射性食管炎2例.结论 体部γ刀立体定向放疗联合吉西他滨单药化疗治疗老年非小细胞肺癌局部控制率较高,疾病进展时间及总生存皆明显改善,不良反应易于耐受.

Stereotactic radiotherapy followed by gemcitabine for elderly patients with advanced non-small cell lung cancer

Objective To study the toxicity and efficacy of sequential Stereotactic radiotherapy and gemcitabine for elderly patients with advanced non-small cell lung cancer.Methods Forty-six elderly patients pathologically diagnosed as suffering from NSCLC received stereotactic radiotherapy by a gamma-knife.A stereotactic body frame for exact tumor localization, low speed computed tomography simulation and three dimensional conformal radiotherapy planning were used for whole body gamma-knife treatment.Chemotherapy consisted of single gemcitabine 1000 mg/m2 on days 1 and 8 was given three or four weeks after radiotherapy, average follow time was eighteen months.Results Forty-six patients received stereotactic radiotherapy, forty-four patients received four cycles chemotherapy, and two patients received two cycles chemotherapy due to fourth class thrombocytopenia.Complete remission, partial remission, SD and PD rate was 4.35% (2 cases), 65.2% (30 cases), 17.4% (8 cases) and 13.0% (6 cases) respectively.Time to progress was 7.7 months, median survival time was 12.6 months.One year survival rate was 56%.No grade 3 and 4 pneumonitis occurred and only two patients experience grade 3 esophagitis.Conclusions Stereotactic radiotherapy followed by gemcitabine improves local control rate, shortens time to progress and overall survival time.Its adverse effects aretolerable.