三维适形放疗同步化疗治疗肺鳞癌的临床观察

目的　观察三维适形放疗联合ＥＰ方案同步放化疗治疗肺鳞癌的疗效及毒副反应。方法　２００４年２月至２００６年１１月收治４２例肺鳞状细胞癌患者于三维适形放疗同步联合ＥＰ方案治疗（适形组），放疗采用常规分割方法，６ＭＶ-Ｘ总剂量６０～６６Ｇｙ；伴锁骨上淋巴结转移均给予６ＭＶ-Ｘ及６-１５ＭｅＶ的电子线，总剂量６５～７０Ｇｙ。另收集同时期常规放疗同步联合ＥＰ方案治疗（常规组）作对照，ＤＴ４０～４４Ｇｙ。两组均于第１周给予ＥＰ方案化疗，从第２周开始实施放疗，化疗２１～２８天为１个周期，连续２个周期。结果　适形组和常规组总有效率分别为９０.５％和７０.７％（Ｐ＝０.０４５），适形组优于常规组；两组１、２年生存率分别为７１.４％、５８.５％和３８.１％、２６.８％，均无显著性差异。放射性食管炎发生率适形组显著低于常规组（Ｐ＝０.０４５）。结论　三维适形放疗同步联合ＥＰ方案与常规放疗同步联合ＥＰ方案治疗肺鳞癌相比能够提高治疗的有效率，两组１、２年生存率相似，适形组明显降低了放疗相关副反应的发生率。

The clinical observation of three dimensional conformal radiotherapy concurrently combined with chemotherapy for lung squamous cell carcinoma

Objective To observe the curative effects and side effects of conventional radiotherapy and three dimensional conformal radiotherapy concurrently combined with EP regimen chemotherapy for lung squamous cell carcinoma.Methods There were 41 patients in conventional group and 42 patients in conformal group.For radiotherapy,we all applied conventional fractionation method and a total dose of 6MV-X was 60-66Gy;patients with supraclavicular lymph node metastasis were given 6MV-X and 6-15MeV electronic ray and a total dose was 65-70Gy.For the two groups,EP regimen chemotherapy was taken in the first week and radiotherapy was conducted in the second week and 21-28 days of chemotherapy was a cycle.The study consisted two cycles.Results The total effective rates in conventional group and conformal group were 70.7% and 90.5%（P=0.045）,1-year and 2-year survival rates were 58.5%,71.4% and 26.8%,38.1%.The radiation esophagitis rate of conventional group was higher than conformal group,which had a significant difference（P=0.045）.Conclusion Compared with conventional radiotherapy combined with EP regimen,three dimensional conformal radiotherapy combined with EP regimen for lung squamous cell carcinoma has better effective rate and survival rate without a significant difference,but the side effect in conformal group is lighter.