非小细胞肺癌调强放化疗的近期疗效观察

目的:分析调强放疗(IMRT)联合化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应.方法:48例局部晚期不能手术或不愿手术的NSCLC患者,采用IMRT同步联合化疗综合治疗.放疗采用5～7野IMRT技术,单次剂量2.0～2,2 Gy,每周5次,中位总剂量60 Gy(54～66 Gy).所有患者均接受2个周期长春瑞滨加顺铂方案同步化疗,放疗结束后辅助2～4个周期化疗.结果:所有患者均顺利完成同步放化疗计划.放疗结束3个月后评价疗效,CR为21％(10/48),PR为60％(29/48),SD为13％(6/48),PD为6％(3/48),有效率为81％(39/48).中位随访时间为11个月(7～30个月),中位生存时间为25个月,1和2年总生存率分别为73％和39％.按RTOG标准评价放疗毒副反应,放射性食管炎Ⅰ级15例,Ⅱ级11例,Ⅲ级1例；放射性气管炎Ⅰ级14例,Ⅱ级8例,Ⅲ级3例；放射性肺炎Ⅰ级6例,Ⅱ级4例,Ⅲ级1例.结论:IMRT联合化疗对局部晚期NSCLC患者有较好的疗效,毒副反应可以被绝大多数患者耐受,对生存率的提高有待进一步研究.

Observation of short-term effect for intensity modulated radiotherapy and chemotherapy in non-small cell lung cancer

OBJECTIVE: To investigate the recent therapeutic effect and adverse effect of the intensity-modulated radiotherapy(IMRT) plus chemotherapy for the locally advanced non-small cell lung cancer(NSCLC).METHODS: Total of 48 patients of locally advanced NSCLC,who was unresectable or unwill to receive surgery,receiving the IMRT and chemotherapy were recruited.Radiation was performed with 5-7 fields IMRT,2.0-2.2 Gy per fraction and 5 fractions per week.The median dose was 60 Gy(54-66 Gy).All patients received two cycles of concurrent chemotherapy with vinorelbine and cisplatin regimens,and followed by 2-4 cycles of consolidate chemotherapy.RESULTS: All patients completed this treatment schedule.The short-term therapeutic effect after three months of the radiotherapy.Complete remission 21%(10/48),partial remision 60%(29/48),stable disease 13%(6/48),and progressive disease 6%(3/48),therefore the effective rate was 81%(39/48).With an median follow up of 11 months(7-30 months),the median survival time was 25 months,1-year and 2-year overall survival rate was 73% and 39%,respectively.According to RTOG criteria,the acute adverse effect were:radiation esophagitis,Ⅰgrade 15 patients,Ⅱ for 11,Ⅲ for 1;radiation bronchitis,Ⅰfor 14 patients,Ⅱfor 8,Ⅲfor 3;radiation pneumonitis,Ⅰ for 6 patients,Ⅱ for 4 and Ⅲ for 1 patients.CONCLUSION: IMRT plus chemotherapy is effective for locally advanced NSCLC with less side effects and well-tolerated approach,further studies needed to improve the overall survival rate.