直线加速器联合γ刀放疗同步DP方案化疗治疗局部晚期非小细胞肺癌的临床研究

目的观察直线加速器联合γ刀放疗同步DP方案化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和不良反应。方法96例局部晚期NSCLC患者随机分为A、B、C三组。A组患者同时接受DP方案化疗及肺内原发灶和阳性淋巴结放疗，6MV X线，50Gy/25F，之后给予γ刀加量20Gy/4F；化疗共4周期。B组患者同时接受DP方案化疗及肺内原发灶和阳性淋巴结放疗，6MV X线，60～66 Gy/30～33F；化疗共4周期。C组患者先接受DP方案化疗2周期后，再给予6MV X线放疗肺内原发灶和阳性淋巴结60～66Gy/30～33F，之后再行DP方案化疗2周期。结果90例患者按计划完成了治疗。A、B、C三组总有效率分别为87.1%、86.7%和62.1%，A、B两组总有效率相当，均高于C组(PAB=1.000，PAC=0.025，PBC=0.030)。三组患者1年总生存率分别为77.4%、73.3%和72.4%，三组相比差异均无统计学意义(PAB=0.711，PAC=0.655，PBC=0.937)。治疗的不良反应主要为急性放射性食管炎、放射性肺炎、骨髓抑制和消化道反应。2级及以上放射性肺炎的发生率分别为323%，60.0% 和20.7%，B组高于A组和C组，A、C两组相当(PAB= 0.030，PAC=0311， PBC=0002)； 2级及以上骨髓抑制的发生率分别为61.3%，66.7%和31.0%，A、B两组相当，均高于C组(PAB=0.662，PAC=0.019，PBC=0.006)；放射性食管炎和消化道反应三组相比差异无统计学意义。结论直线加速器联合γ刀同步DP方案化疗治疗局部晚期NSCLC的近期疗效好，不良反应经对症处理后患者能耐受，但其远期疗效和并发症有待进一步观察。

Clinical Effects of Accelerator Linear Plus Gamma Knife Radiotherapy Combined with Concurrent DP Regimen Chemotherapy for Locally Advanced Non-small Cell Lung Cancer

Objective To investigate the short-term effects and adverse reactions of accelerator linear and gamma knife radiotherapy combined with concurrent DP chemotherapy for locally advanced non-small cell lung cancer(NSCLC).Methods Ninety six patients with locally advanced NSCLC were randomly assigned to three treatment arms.In group A,patients received accelerator linear and gamma knife radiotherapy combined with concurrent 4 cycles of DP chemotherapy.The treatment plans were accelerator linear using 6MV x-rays b...