三维适形放疗与紫杉醇周方案同步治疗老年Ⅲ期非小细胞肺癌的近期疗效观察

目的：评估三维适形放疗与紫杉醇周方案化疗同步治疗老年Ⅲ期非小细胞肺癌（NSCLC）的近期疗效。方法：2006年6月-2008年6月收治的62例老年Ⅲ期非小细胞肺癌患者,予以三维适形放疗,放疗剂量为60-70Gy/6-7周,同时行化疗,为紫杉醇周方案：紫杉醇60mg/m^2,静脉滴注第1,8,15天,28天为1周期。结果：完全缓解率（CR）20.9%,部分缓解率（PR）62.9%,总有效率（CR＋PR）83.8%。不良反应主要为骨髓抑制、消化道反应、放射性肺炎及放射性食管炎。结论：放疗与紫杉醇周方案化疗同步治疗老年Ⅲ期非小细胞肺癌的近期疗效较为满意,不良反应可以耐受。     

分段周量紫杉醇同步三维适形放疗治疗老年非小细胞肺癌

目的探讨分段周量紫杉醇同步三维适形放射治疗老年非小细胞肺癌的临床疗效。方法对经细胞学或病理检查证实的45例老年非小细胞肺癌患者,采用放疗联合紫杉醇同步化疗。放疗采用三维适形放疗技术累及野照射,总照射剂量为60～72 Gy,中位剂量为66 Gy。同步应用紫杉醇60 mg/次,静脉滴注,第1、8、15天及第36、435、0天。结果近期疗效总有效率（CR＋PR）为82.2%,不良反应以骨髓抑制及食管反应为主,但经处理后均能顺利完成治疗;中位生存期21个月,1、2年生存率分别为68.8%、48.8%。结论分段周剂量紫杉醇联合三维适形放疗治疗老年非小细胞肺癌疗效较好,不良反应能耐受,特别适合老年患者,值得临床进一步研究及应用。     

化疗与三维适形放疗同步治疗Ⅲ期非小细胞肺癌的临床观察

三维适形放疗 (ｔｈｒｅｅｄｉｍｅｎｓｉｏｎａｌ ｃｏｎｆｏｒｍａｌｒａｄｉｏｔｈｅｒａｐｙ ,3Ｄ ＣＲＴ)是一项新的放射治疗技术 ,能最大限度地增加肿瘤的局部控制概率 (ＴＣＰ) ,减低周围正常组织的放射并发症(ＮＴＣＰ)。现将我院应用化疗与 3Ｄ ＣＲＴ同步治疗 2 4例Ⅲ期肺癌的初步结果报告如下一、资料与方法1 临床资料 :自 2 0 0 0年 9月至 2 0 0 1年 12月 ,我院收治不能手术切除的Ⅲ期非小细胞肺癌 (ＮＳＣＬＣ)患者 2 4例(ＵＩＣＣｌ997年分期标准 )。男 19例 ,女 5例 ,中位年龄 5 6岁(30～ 78岁 )。 2 4例均经病理学 (纤维支…     

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。     

三维适形放疗联合多烯紫杉醇治疗局部晚期非小细胞肺癌近期疗效观察

目的 探讨和分析三维适形放疗联合多烯杉醇治疗局部晚期非小细胞肺癌患者的近期疗效.方法 选取接受治疗的局部晚期非小细胞肺癌患者90例,按照随机数字表的方法分为观察组(n=45)和对照组(n=45),观察组患者采用三维适形放疗联合多烯紫杉醇的治疗方法,对照组患者仅采用紫杉醇化疗的方案进行治疗.比较两组患者的治疗总有效率,两组患者的不良反应发生率,两组患者治疗后的生活质量良好率.结果 观察组患者的治疗总有效率高于对照组,差异具有统计学意义(P<0.05);观察组与对照组不良反应发生率比较差异无统计学意义(P>0.05);治疗后,观察组患者的生活质量良好率显著高于对照组(P<0.05).结论 三维适形放疗联合多烯紫杉醇对局部晚期非小细胞肺癌患者的效果显著,提高患者生存质量,值得推广应用.     

三维适形放疗联合TP方案治疗Ⅳ期非小细胞肺癌的近期疗效观察

目的：观察三维适形放疗联合紫杉醇/顺铂方案治疗Ⅳ期非小细胞肺癌（NSCLC） 的近期疗效和毒副作用,探讨放疗在Ⅳ期非小细胞肺癌中的应用价值.方法：29例Ⅳ期非小细胞肺癌患者,化疗采用TP方案,紫杉醇135mg/m2,静滴,d1;顺铂40mg/d,静滴,d1-3,,21天为1周期,采用三维适形放疗,常规分割1.8～2.0 Gy/次,1次/d,总剂量50Gy～65Gy/5周～6.5周.结果：29例Ⅳ期NSCLC患者治疗后,中位疾病无进展时间9.0个月,其中CR 3例（10.3%）,PR10例（34.5%）,SD 9例（31.0%）,有效率（CR＋PR）为44.8%,临床受益率（CR＋PR＋SD）75.9%,主要的毒副反应为血液学毒性、胃肠道反应以及放射性肺炎、放射性食管炎等,Ⅱ度以上放射性肺炎的发生率为41.4%,Ⅱ度以上放射性食管炎的发生率为34.5%.结论：三维适形放疗联合TP方案化疗治疗Ⅳ期非小细胞肺癌的近期疗效较为满意,毒副反应可以耐受,值得进一步临床研究.     

非小细胞肺癌的三维适形放疗

1　非小细胞肺癌 (ＮＳＣＬＣ)三维适形放疗　 (3 ｄｉｍｅｎｓｉｏｎａｌｃｏｎｆｏｒｍａｌｒａｄｉａｔｉｏｎｔｈｅｒａ 　ｐｙ ,3Ｄ ＣＲＴ)放疗是局部晚期ＮＳＣＬＣ的主要治疗手段 ,这部分患者占确诊肺癌病例的 40 %左右[1] 。但是局部晚期ＮＳＣＬＣ的治疗结果一直令人失望 ,5年生存率为 5 %～10 %。局部控制率低是造成这种结果的一个主要原因 ,临床研究发现 ,局部控制率仅为 13 %～ 70 % ;用支气管镜活检的方法进行随诊 ,局部控制率为 15 %～17% [2～ 5] 。临床剂量研究显示提高剂量可望提高局部控制率和生存率[2 ,6] 。根据Ｆｌｅ…     

三维适形放疗联合紫杉醇单药每周化学治疗老年非小细胞肺癌的疗效观察

目的 探讨三维适形放疗联合紫杉醇单药每周化疗治疗老年非小细胞肺癌的临床疗效.方法 将88例非小细胞肺癌患者根据治疗方法随机分为2组,分别行三维适形放疗及联合紫杉醇单药化疗.结果 观察组患者治疗后的近期有效率显著高于对照组(P＜0.05).观察组1年局控率、转移率与对照组差异较为显著(P＜0.05),但2组患者2年局控率、转移率以及1年与2年的生存率相比差异不显著(P＞0.05).观察组患者中位生存时间相比对照组显著延长(P＜0.05),血液毒性发生率相比对照组明显升高(P＜0.05).结论 三维适形放疗联合每周紫杉醇单药化疗能够有效治疗老年非小细胞肺癌,能够有效改善近期疗效,延长患者生存期,但不良反应较高.     

三维适形放疗同步化疗治疗Ⅲ期非小细胞肺癌的临床观察

目的:观察三维适形放疗(3DCRT)同期含铂方案化疗治疗不能手术的III期非小细胞肺癌(NSCLC)的疗效、不良反应及生存期。方法:61例III期NSCLC患者31例给予3DCRT同步含铂方案化疗(适形组),30例给予常规放疗(CRT)同步含铂方案化疗(常规组)。两组均采用以铂类为基础的化疗方案先诱导化疗2周期,2周后分别给予3DCRT或CRT。放疗均采用常规分割,总剂量66GY/33F。放疗期间再按期化疗2个周期。结果:两组总有效率分别为87.1%及63.3%,(P<0.05);中位总生存期分别为17个月和14.5月;1、2年局控率分别为77.4%、53.3%和54.8%、29.0%(P<0.05);1年、2年生存率分别70.9%、46.7%(P>0.05)和45.2%、20.0%(P<0.05)。结论:3DCRT同期含铂方案化疗治疗III期NSCLC与常规放疗同步含铂方案化疗相比,能提高有效率和生存率,且放疗相关性不良反应较常规组低。     

三维适形放疗同步化疗治疗Ⅲ期非小细胞肺癌的临床观察

目的：观察三维适形放疗（3DCRT）同期含铂方案化疗治疗不能手术的III期非小细胞肺癌（NSCLC）的疗效、不良反应及生存期。方法：61例III期NSCLC患者31例给予3DCRT同步含铂方案化疗（适形组）,30例给予常规放疗（CRT）同步含铂方案化疗（常规组）。两组均采用以铂类为基础的化疗方案先诱导化疗2周期,2周后分别给予3DCRT或CRT。放疗均采用常规分割,总剂量66GY/33F。放疗期间再按期化疗2个周期。结果：两组总有效率分别为87.1%及63.3%,（P〈0.05）;中位总生存期分别为17个月和14.5月;1、2年局控率分别为77.4%、53.3%和54.8%、29.0%（P〈0.05）;1年、2年生存率分别70.9%、46.7%（P〉0.05）和45.2%、20.0%（P〈0.05）。结论：3DCRT同期含铂方案化疗治疗III期NSCLC与常规放疗同步含铂方案化疗相比,能提高有效率和生存率,且放疗相关性不良反应较常规组低。     

VIP方案加放射治疗晚期非小细胞肺癌的近期疗效观察

目的：评估ＶＩＰ方案化疗与放射治疗晚期非小细胞肺癌（ＮＳＣＬＣ）的近期疗效。方法：观察１９９７年２月～１９９９年２月收治的３３例晚期非小细胞肺癌患。化疗以ＶＩＰ方案为主,２～４周期后行放射治疗,放疗剂量ＤＴ５０～７０Ｇｙ／５～７周。结果：完全缓解（ＣＲ）率为１５．２％,部分缓解率（ＰＲ）为５１．５％,总有效率（ＣＲ＋ＰＲ）为６６．７％。毒副反应主要为Ⅰ～Ⅱ度消化道反应、骨髓抑制及脱发。结论：ＶＩ     

同期减量放化疗与序贯放化疗治疗Ⅲ期非小细胞肺癌的临床试验

目的探讨和比较同期减量放化疗与序贯放化疗治疗不能手术的Ⅲ期NSCLC的毒副反应和近期疗效。方法病理证实为Ⅲa,Ⅲb期（非恶性胸腔积液）不能手术的初治NSCLC患者80例随机分为2组。同期放化疗组（A）：2周期紫杉醇（减半量）＋顺铂（11P）方案化疗,于放疗第一天同期进行。放疗用三维适形放疗,放疗至总量60Gy-70Gy。同期放化疗结束后继续Te（全量）方案巩固化疗3周期。序贯放化疗组（B）：入组后先行放疗,放疗方案同A组,放疗结束后行Te（全量）方案化疗4—5周期。采用WHO近期疗效评价标准和放化疗毒副反应分级标准进行评定。结果A组近期有效率为80．0％,B组为57．5％（x^2=4．71,P〈0．05）,A组Ⅲ,Ⅳ度急性放射性食管炎,白细胞减少,恶心呕吐和皮肤反应发生率分别为47．5％,42．5％,52．5％和57．5％明显高于B组的25．0％,17．5％,30．0％和17．5％（P〈0．05）;A,B组Ⅲ,Ⅳ度急性放射性肺炎,脱发发生率分别为32．5％,7．5％和20．0％,27．5％（P〉0．05）。结论TP方案减量同期放化疗治疗不能手术的Ⅲ期NSCLC,近期疗效较序贯放化疗组高,副反应经积极对症治疗可以耐受。     

Outcomes of concurrent radiotherapy with weekly docetaxel and platinum-based chemotherapy in stage III non-small-cell lung cancer

PurposeThe present study evaluated the outcomes of concurrent weekly docetaxel and platinum-based drug doublet in association with concurrent thoracic radiotherapy (TR) in the curative treatment of stage III locally advanced non-small-cell lung cancer (NSCLC).Patients and MethodsPatients with stage IIIA/B NSCLC were retrospectively included. Patients received weekly docetaxel and either cisplatin or carboplatin intravenous injections during concurrent TR (60 to 66 Gy). Patients who received induction chemotherapy with the same drug doublet were also included. The endpoints were: disease control rate (DCR), overall recurrence rate, survival rates [disease-free survival (DFS) and overall survival (OS)] and toxicity.ResultsEighty-nine consecutive patients treated with this association were included. Median follow-up time was 57.8 months. DCR was 76.5% at the first follow-up CT scan (6 to 12 weeks after the end of concurrent treatment). Median DFS and OS was 14.3 and 29.9 months respectively. Three-year survival was 43%. The overall recurrence rate was 65.9%. During overall treatment, grade 3 to 4 adverse events occurred in 29.2% of patients, the most common being esophagitis (12.4% of patients). Only 13.5% of patients presented with a grade 3 or higher adverse event after the end of concurrent treatment.ConclusionsWeekly docetaxel and platinum-based drug doublet combined with TR yielded promising results in stage III NSCLC, with high survival rates. The toxicity of this association is acceptable, with mainly manageable esophagitis. These findings warrant validation in a prospective study before considering this association for standard of care.     

Comparison of chemotherapy regimens for concurrent chemoradiotherapy in unresectable stage III non-small cell lung cancer

Background

The purpose of this study was to retrospectively compare the survival and toxicities associated with chemoradiotherapy using full-dose and weekly regimens in patients with stage III non-small cell lung cancer.

Methods

Consecutive patients who received concurrent chemoradiotherapy between October 2002 and June 2006 at our institution were enrolled. The prescribed dose for thoracic radiotherapy was 60 Gy in 30 fractions for all the patients.

Results

Fifty-nine patients were enrolled; 36% of the patients were treated with full-dose regimens and 64% with weekly regimens. The patient characteristics were similar in the two groups. In both univariate and multivariate analyses, treatment with weekly regimens was associated with a better overall survival than that with full-dose regimens (2-year survival rates: 75% for weekly regimens vs 41% for full-dose regimens). The toxicities and compliance in the two groups were comparable.

Conclusion

Weekly regimens exhibited more favorable overall survival as compared to full-dose regimens in this retrospective study. Confirmation of the results by a randomized phase III trial is warranted.     

Radiation and chemotherapy for patients with stage III non-small cell lung cancer

Nearly 50,000 people in the United States will be diagnosed with stage III non-small cell lung cancer during the year 2000. Over the past 10 years, combined modality therapy has become the standard of care for primary treatment of most of these patients. Numerous studies and meta-analyses document an improvement in survival for patients with stage III disease treated with sequential chemotherapy followed by chest radiation, compared with radiation alone. Some more recent studies have shown a further improvement in survival when the chemotherapy and full-dose radiation are given concurrently. Acute toxicity is increased compared with sequential chemotherapy followed by radiation, but late toxicities seem similar. A current question under study is whether the use of initial chemotherapy followed by concurrent chemoradiotherapy will further improve median and overall survival compared with immediate concurrent therapy alone.     

Neoadjuvant concurrent chemotherapy and radiotherapy in non-small cell lung cancer

Abstract. Radiotherapy was the standard treatment for patients with locally advanced non-small cell lung cancer until the mid 1990s. Chemotherapy was added in order to improve outcome, and during the last decade sequential, concurrent or mixed modalities have been extensively explored and discussed. Goals of neoadjuvant chemoradiation are resecability and downstaging. Recent published experiences evidenced that neoadjuvant chemoradiotherapy is feasible if delivered with low total dose and limited volume; pathological downstaging to stage 0-I could be a reasonable surrogate end-point for overall and disease free survival and for distant metastasis.     

Phase II study of bi-weekly docetaxel and carboplatin with concurrent thoracic radiation therapy followed by consolidation chemotherapy with docetaxel plus carboplatin for stage III unresectable non-small cell lung cancer

OBJECTIVE: Docetaxel and carboplatin (DC) have demonstrated activity as radiation sensitizers in pre-clinical studies. The aim of this phase II study was to evaluate the efficacy and toxicity of DC with concurrent thoracic radiation therapy (TRT) followed by consolidation chemotherapy with DC for stage III unresectable non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Thirty-three previously untreated patients with inoperable, locally advanced (LA) NSCLC received docetaxel 30 mg/m2 over 1 h and carboplatin at an AUC of 3 every 2 weeks for six courses--four courses during concurrent chemoradiotherapy and two courses following completion of radiotherapy. Concurrent TRT was performed in 2-Gy daily fractions to a total dose of 60 Gy. RESULTS: Among 32 evaluable patients, the overall response rate was 91%, with two complete responses (CR) and 27 partial responses (PR). Median survival time by intention-to-treat analysis was 27 months, with survival rates of 76% at 1 year and 61% at 2 years. Serious side effects were generally limited to grade 3 neutropenia in 6%, grades 3 and 4 pulmonary toxicity in 6 and 3%, respectively, and grade 3 esophagitis in 3% of patients. CONCLUSIONS: DC with concurrent TRT followed by consolidation chemotherapy was highly active with manageable toxicity in patients with stage III unresectable NSCLC.     

Induction chemotherapy followed by concurrent chemoradiotherapy in stage III unresectable non-small cell lung cancer

The favourable experience with the combination regimen of vinorelbine, ifosfamide and cisplatin (NIP) in patients with metastatic non-small cell lung cancer (NSCLC) has led to a protocol assessing this regimen as an induction treatment in patients with stage III unresectable NSCLC, followed by thoracic radiotherapy with concurrent daily cisplatin as a radiosensitizer. Two cycles of NIP were administered 21 days apart; each cycle comprised i.v. vinorelbine 25 mg/m2 on days 1 and 8, i.v. ifosfamide 3 g/m2 on day 1 with MESNA as uroprotection, and i.v. cisplatin 50 mg/m2 on day 1. Radical thoracic radiotherapy commenced on day 43 to a total dose of 64 Gy and i.v. cisplatin 6 mg/m2 was given concurrently prior to each fraction of radiation as a sensitiser. Two more cycles of NIP were given to patients who responded favourably to the induction treatment about 2 weeks after completion of radiation. Between July 1995 and July 1997, 44 patients were treated with this protocol. This treatment schedule was generally well tolerated. Grade 3-4 neutropenia occurred in 50% of the patients and neutropenic sepsis was seen in 8. Grade 3-4 oesophagitis was uncommon. Most of the patients were able to complete the induction and concurrent chemoradiotherapy phase. Major response occurred in 75% of the patients with 2 (4.5%) complete responses (CR). A total of 6 patients achieved CR after chemoradiotherapy. At a median follow-up of 35 months, the median overall survival for all patients was 15 months with a 3-year survival rate of 24%. The median overall survival for stage IIIA patients was 19 months with a 3-year survival rate of 39% in contrast to 13 months' median overall survival and only 15% 3-year survival rate for stage IIIB. The NIP regimen results in a high response rate in NSCLC and this treatment programme seems to benefit selected patients with stage III disease.