逐步递量加速超分割照射加化疗治疗非小细胞肺癌的临床Ⅱ期试验结果分析  

Escalated hyperfractionated accelerated radiotherapy combined with chemotherapy for non-small cell lung cancer: a phase Ⅱ clinical trial

作　　者：陈桂园[1] 王丽娟[1] 蒋国梁[1] 傅小龙[1] 钱浩[1] 赵森[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2005年第3期162-165,共4页Chinese Journal of Radiation Oncology

摘　　要：目的　研究逐步递量加速超分割照射加化疗治疗Ⅲb期非小细胞肺癌的耐受性、副反应和疗效。方法　73例中男5 9例,女14例,中位年龄6 0岁(33～70岁)。放疗方案为2次/d ,间隔>6h ,5d/周。第1、2周,1.2Gy/次,2次/d ;第3、4、5周分别为1.3、1.4、1.5Gy/次,2次/d。肿瘤灶总剂量为6 6Gy ,5 0分次,5周完成。化疗为MVP或EP方案。结果　73例中12例未完成既定的治疗计划。完成的化疗中位疗程数为4个,完成的放疗中位肿瘤灶剂量为6 6Gy。急性放射性食管炎发生率为77% ,其中3级为15 %。急性放射性肺炎发生率为4 0 % ,其中3级为8%。73例的中位生存时间为13个月,1、2年生存率分别为5 1%、10 %。完成既定放疗的6 1例中34例出现局部复发,其中32例在照射野内,2例在野外。1、2年局部控制率分别为71%、34%。1、2年远地转移率分别为5 7%、84 %。结论　逐步递量加速超分割照射加化疗能被绝大多数Ⅲb期患者所耐受,局部控制有所改善,由于远地转移使长期生存并无明显提高。Objective To evaluate the feasibility, toxicity and efficacy of esca lated hyperfractionated accelerated radiation therapy (EHART) combined with chem otherapy for locally advanced non-small cell lung cancer (NSCLC). Methods The E HART was: Irradiation delivered twice per day with >6?h interval and five treat me nt days per week with 1.2?Gy/fraction b.i.d in the first and second weeks, and th en 1.3?Gy/fraction b.i.d, 1.4?Gy/fraction b.i.d and 1.5?Gy/fraction b.i.d in the 3r d , 4th and 5th week, respectively. The total tumor dose was 66?Gy/50 fractions /5 weeks. All patients received neoadjuvant and adjuvant chemotherapy. The chemoth erapeutic regimen was either MVP or EP. From February 1997 to February 1999, 73 patients with stage Ⅲb NSCLC were registered, with a median age of 60 years (3 3-70). Twelve patients withdrew from the study due to Grade Ⅲ acute complicat i ons, distant metastasis, or intercurrent disease. Results Sixty-one patients co m pleted the combined treatment as planned. A median of 4 cycles of chemotherapy ( 1-7) and 66?Gy/50 fractions/36 days were delivered. The most common acute com pli cation was esophagitis occurring in 56 patients (77%),of which 11 (15%) were Gra de Ⅲ. Twenty-nine patients (40%) had acute pulmonary toxicity with 6 (8%) wer e Grade Ⅲ. The median survival time was 13 months. The 1- and 2-year survival r ates were 51% and 10%, respectively. Of the 61 patients who fufilled the require ment of EHART, 34 developed locoregional recurrence with 32 inside and 2 outside of the radiation fields. The 1- and 2 -year locoregional control rates were 7 1% and 34% and the distant metastasis rates were 57% and 84%, respectively. Conclusions EHART combined with chemotherapy could be tolerated by most of the stage Ⅲb NSCLC patients with acceptable complications. Locoregional control is improv ed, but not the long survival predominantly due to distant metastasis.

关 键 词：超分割照射 逐步递量 化疗治疗 试验结果分析 临床Ⅱ期 加速 Ⅲb期非小细胞肺癌 急性放射性食管炎 急性放射性肺炎 远地转移 局部控制率 中位年龄 放疗方案 FP方案 治疗计划 生存时间 局部复发 照射野内 长期生存 发生率 

分 类 号：R734.2[医药卫生—肿瘤]