以顺铂为基础的不同化疗方案同步三维适形放疗对放射性肺炎的影响

目的 探讨以顺铂为基础的不同化疗方案同步三维适形放射治疗局部晚期非小细胞肺癌(NSCLC)对放射性肺炎的影响.方法 回顾性分析120例局部晚期NSCLC,所有患者均接受了以顺铂为基础的联合化疗同步三维适形放射治疗,按化疗方案的不同分为EP(顺铂和足叶乙苷)方案组(57例)、NC(顺铂和多西他赛)方案组(41例)和DC(顺铂和长春瑞滨)方案组(22例),观察3组放射性肺炎的发生、转归及其影响因素.结果 1+2级放射性肺炎EP方案组为33.3％( 19/57),NC方案组为29.3％( 12/41),高于DC方案组22.7％(5/22)]；≥3级放射性肺炎发生率EP方案组为10.5％(6/57),NC方案组为9.7％(4/41),DC方案组为4.5％ (1/22)；但是3组在发生放射性肺炎级别程度上差异无统计学意义(P＞0.05),经治疗后3组发生放射性肺炎患者的转归差异无统计学意义(P＞0.05).结论 以顺铂为基础的化疗方案同步三维适形放射治疗局部晚期NSCLC发生放射性肺炎是可以耐受的,接受顺铂和多西他赛、足叶乙苷、长春瑞滨联合化疗对放射性肺炎影响的差异无统计学意义.但多西他赛能提高肺的耐受性,具有较强的放射增敏效应,对于老年且合并慢性阻塞性肺疾病的患者可考虑优先多西他赛化疗,以减少放射性肺炎的发生.

Cisplatin based chemotherapies combined with three dimensional conformal radiation therapy and radiationpneumonitis

Objective To investigate the effects of radiation pneumonitis in different cisplatin-based concurrent chemotherapy regimens and three-dimensional conformal radiation therapy （3D-CRT）for locally advanced non-small cell lung cancer（NSCLC）. Methods A retrospective analysis of 120 cases with locally advanced nonsmall cell lung cancer was conducted. All patients were treated with cisplatiu-based concurrent chemotherapy and three-dimensional eonformal radiation therapy and randomly divided into EP（ etoposide ＋ cisplatin）regimen group（57 cases）, NC （ vinorelbine ＋ cisplatin） regimen group （g 1 cases ） and DC （ docetaxel ＋ cisplatin） regimen group （ 22 cases）. The occurrence, prognosis and influencing factors of radiation pneumonitis were observed. Results The incidence of 1 and 2 grade radiation pneumonitis was 33.3% （19/57） in EP regimen group, 29. 3% （ 12/41 ） in NC regimen group and 22. 7% （5/22）in DC regimen group. 3 and 4 grade radioactive pneumonia was 10. 5% （6/57）, 9.7% （4/41）, 4. 5% （ 1/22 ）respectively. The differences of levels of radiation pneumonitis in three group were not statistically significant（ P 〉 0.05 ）. Conclusions The radiation pneumonitis in cisplatin-based concurrent chemotherapy and three-dimensional conformal radiation therapy for locally advanced NSCLC are tolerable. The differences of cisplatin plus docetaxel, etoposide or vinorelbine combination chemotherapy are not statistically significant. Docetaxel is more sensitive to radiation than to etoposide and vinorelbine. It is suggested that old patients with chronic bronchitis should first have 3DCRT combined with DC chemotherapy.