适形调强放疗联合化疗治疗中晚期非小细胞肺癌72例

目的:评价三维适形调强放疗联合化疗在治疗中、晚期非小细胞肺癌(NSCLC)的作用。方法:72例中、晚期NSCLC患者采用分组治疗。A组采用常规放疗加化疗,共30例;B组采用三维适形放疗加化疗,共30例;C组采用三维适形调强放疗加化疗,共12例。三组均采用铂类联合盖诺方案化疗1个周期后放疗,放疗结束后再化疗3~5个周期。结果:A组有效率(CR PR)43·3%,B组有效率70%·0,C组有效率83·3%,A组与B组,A组与C组差异有统计学意义,P<0·05;1年生存率:A组40·0%(8/20),B组为66·7%(12/18),C组为100·0%(4/4)。B、C组合并后的1年生存率与A组差异有统计学意义,P=0·03;三组的骨髓抑制等基本相同;放射性食管炎,三组间差异无统计学意义,P=0·16。急性放射性肺炎:A组56·7%,B组33·3%;C组16·7%。A组与C组差异有统计学意义,P=0·031。结论:在中、晚期NSCLC的治疗中,三维适形或调强放疗联合化疗与与常规放疗联合化疗相比,具有疗效好、毒副反应轻、患者容易耐受等特点;适形调强放疗在不增加放疗不良反应的同时,能够提高1年生存率和靶区的照射剂量。

Intensity modulated radiation therapy combined with chemotherapy for medium and late stage non-small cell lung cancer

OBJECTIVE:To evaluate the effect of intensity modulated radiation therapy (IMRT) for medium and late stage non-small cell lung cancer. METHODS: Seventy-two patients with medium and late stage non-small-cell lung cancer were grouped. Group A consisted of 30 patients, receiving conventional radiotherapy plus chemotherapy. Group B consisted of 30 patients, treated with three-dimensional conformal radiotherapy (3-DCRT) plus chemotherapy. Twelve patients were involved in Group C, and IMRT in conjunction with chemotherapy was performed in this group. All these patients received one cycle chemotherapy of Navetbine Cisplatin (NP) before radiotherapy and other three to five cycles after radiotherapy. RESULTS: The overall response rate (CR PR) was 43.3% in Group A, and 70.0%, 83.3% in Group B and C respectively. In Group A there was a significant difference (P<0.05) compared with Group B. The same result could be seen between Group A and C. In terms of one-year survival rate, it was 40% in Group A, and 66.7%, 100.0% in Group B and C respectively. The one-year survival rate in combination with Group B and C was statistically different from that in Group A, P=0.03. Myelosuppression in the three groups was similar. Esophageal toxicity was also observed. There was no statistical difference among the three Groups, P=0.16. Acute radiation-induced pulmonitis was 56.7% in Group A, 33.3% in Group B and 15.7% in Group C. Significant difference was found between Group A and Group C, P=0.031. CONCLUSIONS: 3-DCRT or IMRT combined with chemotherapy in the treatment of non-small cell lung cancer has the feature of good efficacy, less side effects and well-tolerated approach, in contrast with the conventional radiotherapy plus chemotherapy. IMRT can increase not only the one-year survival rate but radiation dose for target, without enhancing the side effect of radiotherapy.