三维适形放疗联合NP方案同步治疗局部晚期非小细胞肺癌的临床研究

目的 观察和评价三维适形放疗联合长春瑞滨和顺铂方案同步治疗局部晚期非小细胞肺癌的疗效和毒副反应.方法 将52例局部晚期非小细胞肺癌患者随机分为同步化放疗(A组)和序贯化放疗(B组).A组采用NP方案化疗,即NVB 25mg/m2d1.8;PDD 25mg/m2d1～3 21d为1周期,同期行三维适形放疗,总剂量为64～66Gy/32～33F,常规分割;B组先行三维适形放疗,方法同A组,放疗结束后休息3～4周,继续接受辅助化疗.A、B组化疗均4周期.结果 同步化放组和序贯化放组的有效率分别为73%和50%,两组差异有统计学意义(P＜0.05).同步治疗组放射性食管炎和放射性肺炎发生率分别为46.2%和30.8%,Ⅲ～Ⅳ度恶心呕吐发生率和骨髓抑制率分别为23.1%和26.9%;序贯化放组放射性食管炎和放射性肺炎发生率分别为38.5%和19.2%,Ⅲ～Ⅳ恶心呕吐发生率和骨髓抑制率分别为11.5%和15.4%.结论 三维适形放疗联合长春瑞滨和顺铂同步化疗较序贯化放疗有效率高,毒副反应相对较重,但均可耐受,因而是治疗局部晚期非小细胞肺癌较理想的方案.

A Clinical Study of Three Dimensional Conformal Radiotherapy Combined with Simultaneous Chemotherapy Using NP Regimens in the Treatment of Locally Advanced Non-Small Cell Lung Cancer

Objective To evaluate the clinical efficacy and toxicity of the three dimensional conformal radiotherapy combined with chemotherapy(vinorebine plus cisplatin) in the treatment of LANSCLC .Methods Fiftytwo patients were randomized into the same two groups:group A(concurrent group) and group B(seguential radiochemotherapy).In group A all the cases received chemotherapy: vinorebine 25mg/m~2 d_1 and d_8,cisplatin 25mg/m~2 d_(1-3),every 21days for four cycles,and three dimensional contormal radiotherapy was performed simultaneously in conventional fraction with total dose 64-66Gy/32-33F.In group B all the cases underwent the same radiotherapy and 3-4 weeks later they continued adjuvant chemotherapy for four cycles.Results The response rates of concurrent group and sequential group were 73% vs 50%(P<0.05).The occurent rate of nausea/vomiting and myelosuppression in group A and B were 19.2%,23.1% vs 11.5%,15.4% respectively.Conclusions The response rates in concurrent group were more than those in the sequential group.Three dimensional conformal radiotherapy and concurrent chemotherapy is a well-tolerated regimen with acceptable toxicity and it is worthy of further clinical trial.