适形放疗同步吉西他滨化疗治疗局部晚期非小细胞肺癌临床研究

目的评价适形放疗同步吉西他滨化疗治疗局部晚期非小细胞肺癌的近期疗效和急性毒副反应。方法90例晚期非小细胞肺癌患者随机分成两组：治疗组45例采用吉西他滨与三维适形放疗同步治疗，对照组45例采用吉西他滨与常规放疗同步治疗。化疗方案为吉西他滨350mg/m^2。第1、8、15、22、29、36天。放射源为6MV或15MVX线，照射靶区包括转移淋巴结及原发灶和预防性淋巴引流区。结果两组的近期疗效：对照组完全缓解5例（11．1％），有效28例（62．2％）；治疗组完全缓解13例（28．9％），有效38例（84．4％）；治疗组的肿瘤缓解率明显高于对照组，组间比较差异有统计学意义（P〈0．05）。对照组的放射性肺炎、放射性食管炎的发生率分别为28．9％（13／45）、35．6％（16／45），明显高于治疗组的11．1%（5／45）、17．8%（8／45），组间比较差异有统计学意义（P〈0．05）。结论适形放疗同步吉西他滨化疗治疗局部晚期非小细胞肺癌能提高局部晚期非小细胞肺癌患者的近期疗效，急性毒副反应明显低于常规放疗同步吉西他滨化疗，值得进一步临床研究，远期疗效有待进一步随访。

Three dimensional conformal radiotherapy combined with gemcitabine chemotherapy for locally advanced non-small cell lung cancer

Objective To evaluate the acute side effects and efficacy of three dimensional conformal radiotherapy （3D-CRT） combined with gemcitabine chemotherapy for locally advanced non-small cell lung cancer （NSCLC）. Methods From January 2006 to December 2007, 90 cases with advanced NSCLC were. divided into two groups, treatment group of 45 patients were treated with 3D-CRT and gemcitabine, control group of 45 patients were treated with gemcitabine and conventional radiotherapy. Chemotherapy consisted of intravenously gemeitabine 350 mg/m2 on day 1, 8, 15, 22, 29, 36. Radioactive source was used with X ray of 6 MV or 15 MV. Irradiatial target area were lung site and mediastinal node. Results The complete remission （CR）and remission rate（RR） in centrol group were 5 cases （ 11.1% ） and 28 cases （62.2%）, but in treatment group were 13 cases （28.9%） and 38 cases （84.4%）, respectively. The difference of response rate in two groups was significant（P 〈 0.05）. The rate of acute radiation-induced pneumonitis and esophagitis in control group （28.9%, 35.6%）were higher than those in treatment group （ 11.1%, 17.8% ）, there were significant difference between two groups （P 〈 0.05）. Conclusions Concurrent application of gemeitabine and 3D- CRT can improve the RR for locally advanced NSCLC,and the acute toxicity are lower than those of gemcitabine and conventional radiotherapy. The clinical study is needed, but the late effect shoud be followed.