适形调强放疗联合化疗治疗中、晚期非小细胞肺癌

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、晚期非小细胞肺癌采用分组治疗。A组采用常规放疗加化疗,共30例,放疗量60～66Gy,B组采用三维适形放疗加化疗,共30例,放疗量64～70Gy;C组采用三维适形调强放疗加化疗,共12例,放疗量70～76Gy。3组均采用铂类联合诺维苯方案化疗1周期后放疗,放疗结束后再化疗3～5周期。结果:A组有效率(CR+PR)43.3%,B有效率70%,C有效率83.3%,A组与B组,A组与C组比较,差异有统计学意义(P<0.05);1年生存率:A组1年生存率40%(8/20),B组为66.67%(12/18),C组为100%(4/4)。B、C组合并后的1年生存率与A组比较,差异有统计学意义(P=0.03);3组的骨髓抑制等基本相同;放射性食管炎:A组56.7%,B组43.3%,C组25%,3组间差异无统计学意义(P=0.16)。急性放射性肺炎:A组56.7%8,B组33.3%;C组16.7%。A组与C组比较,差异有统计学意义(P=0.031)。结论:在中、晚期非小细胞肺癌的治疗中,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、毒副作用轻、病人容易耐受等特点;适形调强放疗在不增加放疗副作用的同时,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:72 cases with medium and late stage non-small-cell lung cancer were grouped. Group A consisted of 30 patients, receiving conventional radiotherapy plus chemotherapy, and their total irradiation dose was 60-66 Gy. Group B consisted of 30 patients, treated with three-dimensional conformal radiotherapy (3-DCRT) plus chemotherapy. The total dose was 64-70 Gy.12 patients were involved in Group C. IMRT in conjunction with chemotherapy was performed in this group, and the total dose was 70-76 Gy.All these patients received one cycle chemotherapy of Navebine+Cisplatin(NP) before radiotherapy and other three to five cycles after radiotherapy.Result:The overall response rate (CR+PR) was 43.3% in Group A, and 70%, 83.3% in Group B and C respectively. In Group A there was 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 66.67%, 100% in Group B and C respectively. The one-year survival rate in combination with Group B and C was statisticaly different compared with Group A(P=0.03).Myelosuppression in the three groups was similar. Esophageal toxicity was also observed. It was 56.7%in Group A, 43.3% in Group B, and 25% in Group C. There was no statistical difference among the three Groups (P=0.16).Acute radiation-induced pneumonitis was 56.7% in Group A, 33.3% in Group B, and 15.7% in Group C. Significant difference was between Group A and Group C(P=0.031).Conclusion:3-DCRT or IMRT combined with chemotherapy for treating non-small-cell lung cancer has the feature of good efficacy, less side effects and well-tolerated approach, contrasting with 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.