三维适形放疗和化疗同步治疗非小细胞肺癌临床分析

目的比较三维适形放疗和化疗同步与单纯化疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效和耐受性.方法对84例初治的ⅢA～Ⅳ期局部晚期NSCLC进行随机分组,同步放化疗组43例(A组),单纯化疗组41例(B组).A组采用NP方案化疗,同期分别给予原发灶和纵隔转移淋巴结区三维适形放疗(TRT),原发灶DT 64～70 Gy,常规分割32～35次(中位剂量66 Gy);B组采用NP方案化疗.结果 A组有效率(CR PR)为65.9%(27/41),其中有6例(14.6%)手术治疗;B组有效率为48.8%(20/41),手术治疗2例(4.8%).A、B两组治疗有效率和手术切除率相比,差异均有显著性(P＜0.05).A组骨髓抑制、肝肾损伤较B组未见明显增加.A组轻、中度放射性食管炎的发生率为53.7%(22/41).结论三维适形放疗同期化疗较单纯化疗有效率(局部控制率)高,手术切除率提高,治疗时间缩短,且耐受性良好,值得推广.

Three dimensional conformal radiotherapy combined with simultaneous chemotherapy vs chemotherapy alone in treatment of non-small-cell lung cancer

Objective To compare the efficacy and tolerability of three-dimensional conformal radiotherapy combined with simultaneous chemotherapy vs chemotherapy alone in the treatment of non-small-cell lung cancer.Methods Eighty-four patients were randomized into two groups, 43 patients in group A underwent dimensional conformal radiotherapy combined with chemotherapy and 41 patients in group B were treated with chemotherapy alone.Group A chemotherapy regimen: navelbine, 25 mg/m2, d1 and 8,cisplatin 25 mg/m2 d2,3 and 4, 21 days constituted a cycle.Radiotherapy regimen: dose for primary tumor bed was D_T 64-70 Gy,conventionally divided into 32-35 fractions(median dose 66 Gy).Chemotherapy regimen in group B was same as group A.Results The local response rate (CR+PR) of group A was 65.9%(27/41).Of them,6(14.6%)were surgically resected.The response rate(CR+PR) of group B was 48.8%(20/41).Of them,2(4.8%) underwent surgical resection. The response rates and the surgical resection rates were significantly different between the 2 groups(P<0.05).Compared with group B, the side effects including leucopenia and the damage to liver and kidney were not significantly increased in group A and the incidence rate of esophagitis in group A was 53.7%(22/41).Conclusions Compared with the response rate of chemotherapy alone,the response rate of the patients treated with three dimensional conformal radiotherapy combined with simultaneous chemotherapy was increased (65.9 % vs 48.8%), the surgical resection rate was increased (14.6% vs ~4.8% )and the time of treatment was shortened.The combined treatment was well tolerated by the patients and is worthy of spreading.