体部伽玛刀联合培美曲塞与卡铂治疗晚期非小细胞肺癌临床观察

目的观察体部伽玛刀联合培美曲塞（Pem etrexed）与卡铂（Carbop latin）治疗局部晚期非小细胞肺癌（NSCLC）的临床疗效及毒副反应。方法39例局部晚期非小细胞肺癌患者,以培美曲塞（500 mg.m-2）、卡铂（300 mg.m-2）方案化疗两个周期,然后进行体部伽玛刀治疗,单次治疗剂量3.0~5.5 Gy,等剂量曲线50%~75%,计划靶体积（PTV）覆盖95%以上临床靶体积（CTV）,总剂量50~60 Gy,治疗后再按此方案化疗2个周期。与同期76例单纯伽玛刀治疗局部晚期NSCLC患者治疗结果相比较。结果39例患者,1例完全缓解（CR）,30例部分缓解（PR）,5例稳定（SD）,3例进展（PD）,近期有效率为79.49%（31/39）,6、12和24个月生存率分别为82.05%（32/39）、56.41%（22/39）和35.90%（14/39）,中位生存期16个月。主要不良反应表现为Ⅰ~Ⅲ度的血液系统毒性和胃肠道反应,未发生Ⅳ度急性反应。同期单纯伽玛刀治疗患者,近期有效率为76.32%（58/76）,6、12和24个月生存率分别为78.95%（60/76）、44.74%（34/76）和23.68%（18/76）。结论体部伽玛刀联合培美曲塞及卡铂是一种对局部晚期非小细胞癌比较有效的治疗方法,毒性反应较轻,临床使用安全。

Body-gamma knife combined with pemetrexed plus carboplatin as the therapy in treating the advanced non-small-cell lung cancer

Aim To investigate the clinical therapeutic effectiveness and side effects of body-gamma knife combined with pemetrexed plus carboplatin as the therapy in treating the local advanced non-small-cell lung cancer(NSCLC).Methods A total of 39 advanced NSCLC were enrolled in this study.At first,patients received the chemotherapy with pemetrexed(500 mg·m-2) and carboplatin(300 mg·m-2) for two cycles.Then body gamma knife was executed.The dosage was 3 to 5.5 Gy.The isodose curve was 50%~75%.The target volume(PTV) covered about 95% of the clinical target volume(CTV).The total dose was 50 to 60 Gy.Finally,the same regimen was used for more two cycles.The body-gamma knife treatment outcome was compared with 76 locally advanced NSCLC cases during the same period.Results Among the 39 patients,there was 1 case with complete response,30 cases partial response,5 cases stable disease and 3 cases progressive disease.The short-term effective rate was 79.49%(31/39).6,12,24-month survival rate was 82.05%(32/39),56.41%(22/39) and 35.90%(14/39),respectively.Median survival duration was 16 months.The common adverse effects were neutropenia and gastrointestinal response.Among 76 patients with single body gamma knife treated,The short-term effective rate was 76.32%(58/76),6,12,24-month survival rate was 78.95%(60/76),44.74%(34/76)and 23.68%(18/76),respectively.Conclusions Body-gamma knife combined with pemetrexed plus carboplatin is effective in the treatment of advanced NSCLC,with mild to moderate side effect and safety in clinical practice.