长春瑞滨联合顺铂同步放疗治疗局部晚期非小细胞肺癌

目的观察Ⅲ期非小细胞肺癌患者应用顺铂联合长春瑞滨同步放疗的治疗效果和相关影响因素。方法三维适形放疗联合化疗治疗50例不能手术的ⅢA (N2)~ⅢB期NSCLC患者。顺铂30 mg/m2，第1~3、22~24天；长春瑞滨20 mg/m2，第1、8、22、29天。三维适形放疗在第1天开始，放疗中位剂量64Gy。CTC 3.0版用于评价治疗不良反应。结果50例患者客观缓解率为70%。局部肿瘤无进展中位生存时间和中位生存时间分别为7.5月和16.1月。1、2、3年生存率分别为60%、32.7%和21%。多因素分析结果显示高剂量照射（＞64Gy）组病人的局部区域控制率和生存率好于低剂量照射组（≤64Gy），总疗程时间是病人生存率的影响因素，疗程时间短的病人生存率好。9名病人出现了3级血液不良反应。20人出现1~2级急性放射性食管炎；26人出现1~2级急性放射性肺炎。结论长春瑞滨联合顺铂和同步放疗治疗局部晚期非小细胞肺癌是可行的。提高放疗剂量或缩短疗程时间可以提高局部晚期非小细胞肺癌病人的生存率。

Concurrent Radiotherapy and Chemotherapy of Vinorelbine and Cisplatin for Locally Advanced Non-small Cell Lung Cancer

ObjectiveTo analysis the toxicities and efficacy of concurrent irradiation and chemotherapy in unresectable locally advanced non-small cell lung cancer (NSCLC). MethodsFrom April 2002 to June 2006, 50 unresectable stage ⅢA(N2) ~ⅢB NSCLC patients received 2 cycles of cisplatin-based chemotherapy with cisplatin（CDDP）30 mg/m2 on day 1～3 and 22~24 and Vinorelbine（VNR）20 mg/m2 on day 1, 8, 22 and 29. Three-dimensional conformal radiotherapy (3DCRT) was administered concurrently in cycle 1 and median radiation dose was 64 Gy. Common terminology criteria for adverse events version 3.0 was used to assess treatment-related adverse events. ResultsThe response rate was 70%. The median survival of disease progression-free and median overall survival(OS) were 7.5 months and 16.1 months, respectively. The 1-, 2- and 3-year survival rates were 60%, 32.7% and 21%, respectively. In the univariaty analysis, clinical stage and dose of radiation were significantly associated with survival and dose of radiation was significantly associated with progression-free survival(PFS). In the multivariate analysis, dose of radiation was significantly associated with OS and PFS. Toxicities were well tolerated. Grade 3 hematologic toxicities consisted mainly of neutropenia (10%). Twenty-six patients presented with grade 1~2 symptomatic radiation pneumonitis. Grade 1~2 acute esophageal toxicity was observed in 20 patients. ConclusionBased on this experience with 50 patients, this concurrent radiotherapy and chemotherapy for inoperable stage Ⅲ NSCLC was feasible with acceptable toxicity.