紫杉醇周方案与三维放疗同步治疗Ⅲ期非小细胞肺癌的临床观察

目的评估紫杉醇周方案与三维放疗同步治疗Ⅲ期非小细胞癌的疗效和毒副反应。方法 47例Ⅲ期非小细胞肺癌患者予三维放疗(三维适形或适形调强),同时予紫杉醇化疗(45 mg.m-2,每周1次,共6周)。结果全组有效率为70.2%,中位生存期15.5个月,1、2 a生存率分别为68.1%、36.2%。结论紫杉醇周方案与三维放疗同步治疗Ⅲ期非小细胞肺癌有较好的疗效,毒副反应可耐受。     

联合放化疗和单纯放疗治疗非小细胞肺癌对比分析

[目的]探讨放化疗综合治疗和单纯放疗治疗非小细胞肺癌的疗效。[方法]2001年6月至2004年12月92例非小细胞肺癌患者纳入分析,其中放化疗综合治疗51例．常规放疗41例;对比观察两组患者的近期疗效,1、2、3年生存率,中位生存期和毒副反应。[结果]放化疗综合组和单纯放疗组有效率分别为70．6％和48．8％（P〈0．05）,1、2、3年生存率分别为72．5％、43．1％、29．7％和61．0％、34．1％、15．1％,中位生存期分别为22和19个月。两组毒副反应发生率无显著性差异。[结论]放化疗综合治疗非小细胞肺癌的疗效优于单纯放射治疗。     

诱导化疗联合三维适形放疗治疗48例局部晚期非小细胞肺癌

[目的]评价诱导化疗加三维适形放射治疗（3DCRT）治疗局部晚期非小细胞肺癌（NSCLC）的疗效及毒副反应。[方法]经病理学或细胞学确诊的78例局部晚期NSCLC患者随机分为单纯3DCRT治疗组（RT组，30例）和诱导化疗与3DCRT联合治疗组（CMT组，48例）。CMT组在3DCRT治疗前给予2～4个周期以铂类药物为主的静脉化疗。[结果]全组中位生存期12．5个月，CMT组中位生存期15个月，RT组中位生存期10个月（P=0．453）。1年生存率CMT组为70．8％，RT组为43．3％（P=0．016）：2年生存率CMT组为37．5％，RT组为26．6％（P=0．323）。两组毒副反应相似，化疗的毒副反应患者能耐受。[结论]诱导化疗加三维适形放疗治疗晚期NSCLC可延长生存期，但并不增加放射副反应。     

NP和GP方案治疗晚期非小细胞肺癌疗效比较

[目的]探讨吉西他滨联合顺铂方案(GP)及异长春花碱联合顺铂方案(NP)治疗晚期非小细胞肺癌的疗效及毒副反应.[方法]晚期非小细胞肺癌35例采用GP方案,38例采用NP方案,治疗2个周期后评价疗效及毒副反应.[结果]总有效率GP组为45.8%,NP组为52.6%;中位生存期分别为10.5和9.9个月,两组比较无显著性差异(P＞0.05).主要的毒副反应为血液毒性.[结论]GP和NP方案治疗晚期非小细胞肺癌疗效肯定且相似,毒副反应可以耐受.     

诱导化疗联合三维适形放疗治疗48例局部晚期非小细胞肺癌

[目的]评价诱导化疗加三维适形放射治疗（3DCRT）治疗局部晚期非小细胞肺癌（NSCLC）的疗效及毒副反应。[方法]经病理学或细胞学确诊的78例局部晚期NSCLC患者随机分为单纯3DCRT治疗组（RT组，30例）和诱导化疗与3DCRT联合治疗组（CMT组，48例）。CMT组在3DCRT治疗前给予2～4个周期以铂类药物为主的静脉化疗。[结果]全组中位生存期12．5个月，CMT组中位生存期15个月，RT组中位生存期10个月（P=0．453）。1年生存率CMT组为70．8％，RT组为43．3％（P=0．016）：2年生存率CMT组为37．5％，RT组为26．6％（P=0．323）。两组毒副反应相似，化疗的毒副反应患者能耐受。[结论]诱导化疗加三维适形放疗治疗晚期NSCLC可延长生存期，但并不增加放射副反应。     

局部晚期非小细胞肺癌同步放化疗临床疗效分析

目的:探讨同步放化疗治疗晚期非小细胞肺癌的近期疗效、生存期、毒副反应.方法:55例局部晚期非小细胞肺癌分为同步放化疗组:26 例, 放疗组:29 例.同步组化疗采用以铂类药物为主组成的化疗方案,中位化疗周期数为3周期.放疗采用钴60γ线,DT60Gy～70Gy;分割剂量为2Gy/(次/d),5次/周.分别比较两组的近期疗效、生存率、毒副反应.结果:同步组与放疗组病例有效率分别为76.9%和58.6%,近期疗效差异有显著性意义 .1、2、3年生存率及中位生存期同步组分别为:69.2%、40.1%、21.1%和18个月.放疗组为:53.9%、20.5%、6.8%和13个月,两组差异有显著性意义.结论:同步放化疗治疗局部晚期非小细胞肺癌优于单纯放疗,同步放化疗治疗非小细胞肺癌虽增加了治疗毒副反应,但可以耐受.     

局部晚期非小细胞肺癌同步放化疗临床疗效分析

目的：探讨同步放化疗治疗晚期非小细胞肺癌的近期疗效、生存期、毒副反应。方法：55例局部晚期非小细胞肺癌分为同步放化疗组：26例,放疗组：29例。同步组化疗采用以铂类药物为主组成的化疗方案,中位化疗周期数为3周期。放疗采用钴^60γ线,DT60Gy-70Gy;分割剂量为2Gy/（次/d）,5次/周。分别比较两组的近期疗效、生存率、毒副反应。结果：同步组与放疗组病例有效率分别为76.9%和58.6%,近期疗效差异有显著性意义。1、2、3年生存率及中位生存期同步组分别为：69.2%、40.1%、21.1%和18个月。放疗组为：53.9%、20.5%、6.8%和13个月,两组差异有显著性意义。结论：同步放化疗治疗局部晚期非小细胞肺癌优于单纯放疗,同步放化疗治疗非小细胞肺癌虽增加了治疗毒副反应,但可以耐受。     

诱导化疗联合三维适形放射治疗对局部晚期非小细胞肺癌治疗的临床研究

目的:评价诱导化疗加三维适形放射治疗(3DCRT)治疗局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及并发症。方法:经病理细胞学确诊的35例局部晚期NSCLC患者,采用在3DCRT治疗前给予2~4个周期多西他赛75mg/(m2·d),21d为1个周期的化疗。结果:中位总生存期18个月,1年生存率为71·4%,2年生存率为37·1%。毒副反应患者能耐受。结论:诱导化疗加三维适形放疗治疗晚期NSCLC可延长生存期,但并不增加放射不良反应。     

同步放化疗治疗局部晚期非小细胞肺癌的临床观察

目的 观察同步放化疗治疗不能手术的局部晚期非小细胞肺癌(NSCLC)的临床疗效和毒副反应.方法 31例局部晚期NSCLC入组行同步放化疗.放疗范围为原发灶和阳性淋巴结区域,使用三维适形放疗或常规放疗,肿瘤剂量为65～70 Gy;化疗采用多西他赛+顺铂,4周为1个周期,所有患者至少完成2个周期,有效者给予4个周期.结果 31例NSCLC中,CR 4例,PR 19例,SD 5例,PD 3例,有效率为74.2%.中位生存期16.5个月;1年生存率64.5%,2年生存率35.5%.治疗失败的主要原因是远处转移.主要毒副反应是骨髓抑制、恶心呕吐、放射性食管炎和放射性肺炎.结论 同步放化疗治疗不能手术的局部晚期NSCLC患者疗效较好,毒副反应可耐受.     

放化疗联合治疗对Ⅳ期非小细胞肺癌的疗效对比研究

目的:探讨三维适形放射治疗(3-dementional conformal radiation therapy,3D-CRT)在Ⅳ期非小细胞肺癌中的临床应用,为晚期非小细胞肺癌患者,特别是老年、伴有内科疾病及一般状况差的病人提供安全、有效的治疗方法。方法:回顾性分析我院2007年12月-2010年12月258例初诊经组织学或细胞学证实的Ⅳ期非小细胞肺癌患者。根据治疗方式不同分三组:单纯放疗组、单纯化疗组、放化联合组进行对照。结果:单纯放疗组、单纯化疗组、放化联合组中位生存时间分别为9个月、11个月和13个月;0.5年生存率为75.8%、71.8%和85.1%;1年生存率为29.8%、40.5%和56.4%;2年生存率为9.1%、12.3%和14.5%;近期有效率分别为57.6%、42.0%、64.9%;进展率分别为48.5%、49.6%、40.4%;中位无进展时间分别为6个月、7个月、9个月。放疗与化疗结合并未增加化疗的毒副反应(P>0.05)。结论:3D-CRT联合化疗应用于Ⅳ期非小细胞肺癌,较单纯化疗和单纯放疗提高了中位生存期和0.5年、1年、2年生存率,而并未增加毒副反应;对老龄、合并内科疾病、一般状况差的病人单纯精确放疗也取得了比较理想的效果。     

Three-dimensional conformal radiation therapy (3D-CRT) for early-stage non-small-cell lung cancer

The standard treatment for early-stage non-small-cell lung cancer is surgical resection. However, many patients are inoperable due to medical comorbidities. Thirty-two medically inoperable patients with early-stage non-small-cell lung cancer were treated with 3-dimensional conformal radiation therapy between January 1991 and December 2000. The median dose was 70.2 Gy, and the median follow-up time in survivors was 30 months. The 2-year actuarial local control, overall survival, and cancer-specific survival rates were 43%, 54%, and 57%, respectively. The 5-year actuarial local control, overall survival, and cancer-specific survival rates were 43%, 33%, and 39%, respectively. This report suggests that local control is improved with high-dose conformal radiation therapy when compared to other institutions' retrospective experiences.     

Induction chemotherapy plus three-dimensional conformal radiation therapy in the definitive treatment of locally advanced non-small-cell lung cancer

PURPOSE: To evaluate our institution's experience using chemotherapy in conjunction with three-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS: From 1991 to 1998, 152 patients with Stage III non-small-cell lung cancer (NSCLC) were treated with 3D-CRT at Memorial Sloan-Kettering Cancer Center. A total of 137 patients (90%) were surgically staged with either thoracotomy or mediastinoscopy. The remainder were staged radiographically. Seventy patients were treated with radiation therapy alone, and 82 patients received induction chemotherapy before radiation. The majority of chemotherapy-treated patients received a platinum-containing regimen. Radiation was delivered with a 3D conformal technique using CT-based treatment planning. The median dose in the radiation alone group was 70.2 Gy, while in the combined modality group, it was 64.8 Gy. RESULTS: The median follow-up time was 30.5 months among survivors. Stage IIIB disease was present in 36 patients (51%) in the radiation-alone group and 57 patients (70%) in the combined-modality group. Thirty-nine patients had poor prognostic factors (KPS < 70 or weight loss > 5%), and they were equally distributed between the two groups. The median survival times for the radiation-alone and the combined-modality groups were 11.7 months and 18.1 months, respectively (p = 0.001). The 2-year rates of local control in the radiation-alone and combined-modality groups were 35.4% and 43.1%, respectively (p = 0.1). Grade 3 or worse nonhematologic toxicity occurred in 20% of the patients receiving radiation alone and in 16% of those receiving chemotherapy and radiation. Overall, there were only 4 cases of Grade 3 or worse esophagitis. CONCLUSION: Despite more Stage IIIB patients in the combined-modality group, the addition of chemotherapy to 3D-CRT produced a survival advantage over 3D-CRT alone in Stage III NSCLC without a concomitant increase in toxicity. Chemotherapy thus appears to be beneficial, even in patients who are receiving higher doses of radiation therapy than are typically given with conventional techniques. Because locoregional failure remains a major challenge in patients with advanced disease, 3D-CRT in conjunction with chemotherapy may allow safe treatment to the dose levels required to further enhance local control.     

28例不能手术的肝外胆道系统肿瘤放化疗疗效分析

目的 评价放疗晚期肝外胆道系统肿瘤的疗效。方法 对28例手术不可切除的肝外胆道系统肿瘤采用放化疗，其中胆囊癌13例，肝外胆管癌15例。15例采用常规放疗，中位照射剂量45Gy（30～60Gy），13例采用三维适形放疗（3DcRT）多野（3～5个野）照射或加量，中位照射剂量55Gy（50～70Gy）。12例单纯放疗，16例放化结合。化疗方案为氟尿嘧啶500mg，2次／周，或氟尿嘧啶500mg＋顺铂30mg，1次／周，疗程3～6个周期。结果 全部患者近期有效率14％。全组中位生存期9．4个月（2～28个月）。1、2年生存率分别为38％、15％；其中1年生存率胆囊癌为46％，肝外胆管癌为27％，3DCRT为42％，常规放疗为33％，单纯放疗为37％，放疗＋化疗为31％；〈50Gy的为29％，≥50Gy的为45％。只有照射剂量（≥50Gy）对1年生存率有影响（X^2=5．31，P=0．023）。急性消化道反应1～2级为57％，3级为18％，仅有25％的出现1～2级血液毒性反应。结论 对晚期肝外胆道系统肿瘤采用放化疗可取得一定疗效，且副作用可耐受。     

Multivariate analysis of survival, local control, and time to distant metastases in patients with unresectable non-small-cell lung carcinoma treated with 3-dimensional conformal radiation therapy with or without concurrent chemotherapy

BACKGROUND: Three-dimensional (3D) conformal radiation therapy (CRT) and chemotherapy have recently improved lung cancer management. PATIENTS AND METHODS: We reviewed outcomes in 68 patients with unresectable stage I-III non-small-cell lung cancer. Treatment consisted of 3D CRT alone or with concurrent chemotherapy (CCR). RESULTS: Concurrent chemotherapy improved survival, to a median of 17 months +/- 4.9 months, compared with 8 months+/- 4.1 months for the radiation therapy (RT) alone group (P=0.0347). The 2- and 5-year survival rates were 40.3%+/-7.7% and 14.1%+/-6.4%, respectively, with CCR, compared with 19.6%+/- 9.6% and 0, respectively, for RT alone. In a subgroup analysis for age > 65, patients who received CCR (n=20) had significantly improved survival and local control (P=0.005 and P=0.0286, respectively). Acute esophageal toxicity Radiation Therapy Oncology Group grade >or= 3 was significantly higher in the CCR group and correlated with the RT dose (19% in CCR vs. 0 in RT, P=0.0234; P=0.050). The overall incidences of esophageal and pulmonary toxicity grade >or= 3 were 20.6% and 5.9%, respectively. CONCLUSION: Our study confirms that CCR is associated with improved survival over RT alone, with a tolerable increase in acute toxicity.     

Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer

PURPOSE: To evaluate the efficacy and toxicity of hypofractionated stereotactic body radiotherapy in patients with Stage I/II non-small-cell lung cancer. METHODS AND MATERIALS: Forty-three patients with inoperable Stage I/II non-small-cell lung cancer underwent treatment prospectively using the stereotactic gamma-ray whole-body therapeutic system (body gamma-knife radiosurgery) with 30 rotary conical-surface Co(60) sources focused on the target volume. Low-speed computed tomography simulation was conducted, which was followed by three-dimensional conformal radiotherapy planning. A total dose of 50 Gy was delivered at 5 Gy/fraction to the 50% isodose line covering the planning target volume, whereas a total dose of 70 Gy was delivered at 7 Gy/fraction to the gross target volume. The median follow-up duration was 27 months. RESULTS: Three to 6 months after treatment, the complete response rate for body-gamma knife radiosurgery was 63%, and the overall response rate was 95%. The 1-year, 2-year, and 3-year local control rates were all 95% in all patients. The 1-year, 2-year, and 3-year overall survival rates were 100%, 91%, and 91%, respectively, in patients with Stage I disease and 73%, 64%, and 64%, respectively, in those with Stage II disease. Only 2.3% (1/43) of the patients had Grade 3 pneumonitis. CONCLUSION: Our highly focused stereotactic body radiotherapy method resulted in promising local control and survival with minimal toxicity.     

靶向药物同步个体化放疗治疗晚期/转移性非小细胞肺癌的Ⅱ期临床研究

目的探索靶向药物吉非替尼或厄洛替尼同步个体化放疗治疗晚期/转移性非小细胞肺癌(NSCLC)的安全性和有效性,探索肿瘤综合治疗的新模式。方法 21例经病理组织学确诊的Ⅳ期NSCLC接受表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)吉非替尼或厄洛替尼同步胸部放疗。胸部放疗采用根治性为目的的适形放疗(CRT)和/或伽马射线立体定向放疗(γ-SBRT)。不良反应依据美国国立癌症研究院常见不良反应标准(NCI-CTCAE3.0)评价。主要研究终点为安全性,总生存(OS)和中位生存时间(MST)。次要研究终点为肿瘤局部控制率、肿瘤进展时间(TTP)、无进展生存(PFS)。结果吉非替尼或厄洛替尼同步个体化放疗的皮肤不良反应、消化道反应和血液学不良反应可控,没有导致严重的肺部不良反应。接受胸部放疗计划的患者中位肿瘤靶区容积(GTV)是55 cm~3(范围,5～420 cm~3),GTV边缘中位剂量是70Gy(范围,42～70Gy),中位生物等效剂量(BED)是105Gy(范围,60～119Gy)。EGFR-TKIs中位维持治疗时间是8.1个月(范围,1.9～29.0个月),EGFR-TKIs同步放疗没有发生治疗相关性死亡。中位随访10.0个月(范围,1.1～38.3个月),胸部肿瘤局部控制率为95%,中位TTP为5.8个月(范围,1.2～18.6个月),中位PFS为7.8个月(95%的可信区间,1.7～13.9个月),MST为21.8个月(95%的可信区间,5.3～38.4个月),1年PFS为39%,1年、2年和3年的OS分别为41%、24%和24%。结论靶向药物同步放疗安全有效,可以作为晚期/转移性NSCLC的治疗选择。     

吉西他滨联合顺铂治疗晚期非小细胞肺癌临床研究

目的比较晚期非小细胞肺癌采用吉西他滨加顺铂与长春瑞滨加顺铂化疗的疗效、生存期和毒副作用.方法 60例晚期非小细胞肺癌患者随机分为两组,A组30例,采用吉西他滨加顺铂;B组30例,采用长春瑞滨加顺铂,进行疗效分析和毒副作用比较.结果 A组CR 3例,PR 15例,总有效率60.0%,1年生存率33.3%,中位生存期9.4个月,肿瘤进展时间2～20个月,Karnofsky平均提高15分;B组CR 1例,PR 13例,总有效率46.7%,1年生存率16.7%,中位生存期6.4个月,肿瘤进展时间3～16个月,Karnofsky平均提高10分,两组间总有效率、1年生存率差异有显著性(P<0.05).最常见的毒副反应为骨髓抑制,A组为血小板减少,B组为白细胞减少.结论吉西他滨加顺铂治疗晚期非小细胞肺癌疗效明确,耐受性好.     

A phase II study of concurrent accelerated hyperfractionated radiotherapy and carboplatin/oral etoposide for elderly patients with stage III non-small-cell lung cancer

PURPOSE: To investigate feasibility, toxicity, and efficacy of accelerated hyperfractionated radiation therapy and concurrent carboplastin/oral etoposide in elderly (> 70 years) patients with stage III non-small-cell lung cancer. METHODS AND MATERIALS: Between January 1988 and June 1993, a total of 58 patients entered a phase II study. Carboplatin (400 mg/m(2)) was given intravenously on days 1 and 29, and etoposide (50 mg/m(2)) was given orally on days 1-21 and 29-42. Accelerated hyperfractionated radiotherapy was administered starting on day 1, with a total dose of 51 Gy in 34 fractions over 3.5 weeks. RESULTS: In 55 evaluable patients, the complete response rate was 27% and the overall response rate was 65%. For the 55 patients, the median survival time was 10 months, and the 1-, 2-, and 5-year survival rates were 45%, 24%, and 9.1%, respectively. The median time until relapse was 8 months and the 1-, 2-, and 5-year relapse-free survival rates were 45%, 20%, and 9.1%, respectively. The median time to local recurrence was 14 months and the 5-year local control rate was 13%; the median time to distant metastasis was 18 months and the 5-year distant metastasis-free rate was 15%. Hematological, esophageal, and bronchopulmonary acute grade 3 or 4 toxicities were observed in 22%, 7%, and 4% of the patients, respectively. There was no grade 5 toxicity or late grade > or = 3 toxicity. CONCLUSION: Concurrent accelerated hyperfractionated radiotherapy and carboplatin/oral etoposide produced relatively low and acceptable toxicity. The survival results appeared to be comparable to those obtained in nonelderly patients with stage III non-small-cell lung cancer treated by full-dose radiation.     

后程三维适形大分割放疗并序贯化疗治疗Ⅲ期非小细胞肺癌

 目的　观察常规分割放疗基础上后程三维适形大分割放疗并序贯化疗治疗非小细胞肺癌（NSCLC）的疗效。方法　62例符合条件的Ⅲ期NSCLC患者入组。先予NP方案化疗2个周期，化疗结束20余天待WBC恢复正常后开始放射治疗，放射治疗的前半程予前后对穿大野照射，常规分割2 Gy／次，剂量40 Gy，20次，之后针对肺部原发灶及纵隔内≥1 cm的转移淋巴结用三维适形放疗技术采用大分割放疗4～6 Gy／次，间隔1～2 d，剂量24～30 Gy，4～6次。锁骨上有淋巴结转移者采用60Co或6 MV-X线加电子线常规分割放疗至总量64～66 Gy。放射治疗结束后再追加化疗2个周期。结果　62例患者全部完成治疗计划，随访3年。肺原发灶完全缓解（CR）9例，部分缓解（PR）40例。肿瘤总有效率为79.0 ％。1、2、3年生存率为71.0 ％、48.4 %、30.6 %。1、2、3年局控率为80.6 %、62.9 ％、40.3 %。急性不良反应主要有：急性放射性食管炎、气管炎、胃肠道反应以及骨髓抑制，经过对症处理后均能完成治疗。结论　在常规分割放疗基础上后程行三维适形大分割放疗并序贯化疗治疗NSCLC有较好的疗效和能为患者接受的不良反应。