术前同期放化疗治疗肺上沟瘤的疗效分析  

Analysis of preoperative concurrent chemoradiotherapy in the treatment of patients with superior sulcus tumor of the lung

作　　者：王文武[1] 欧阳学农[1] 姜浩[2] 樊光华[3] 

机构地区：[1]国家中西医结合肿瘤重点专科,南京军区福州总医院肿瘤科350025 [2]南华大学附属第一医院 [3]江西省肿瘤医院

出　　处：《中国肺癌杂志》2007年第1期37-39,共3页Chinese Journal of Lung Cancer

摘　　要：背景与目的近年来,放疗联合化疗的综合治疗已取代单纯放疗而成为不能手术的局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。肺上沟瘤是NSCLC的一个独特的临床亚型。本研究的目的是比较术前同期放化疗与单纯放疗治疗肺上沟瘤的临床疗效和毒性反应。方法56例肺上沟瘤随机分组,26例进入同期放化疗组,30例进入单纯放疗组。同期放化疗组化疗方案：异长春花碱15-18mg/m^2第1、8天,顺铂60mg/m^2第1天;放射治疗从第一天开始,放疗总剂量为45Gy,1.8-2.0Gy/次,每周5次,共5周时间。单纯放疗组：放射治疗方案同同期放化疗组。结果所有患者均顺利完成治疗。同期放化疗组的手术完整切除率（92.3%）明显高于单纯放疗组（80.0%）（P〈0.05）;同期放化疗组完全病理缓解率（84.6%）、2年生存率（92.3%）显著高于单纯放疗组（分别为33.3%和46.7%）（P〈0.01,P〈0.01）。同期放化疗组的Ⅲ~Ⅳ度放射性食管炎和白细胞下降发生率均为23.1%,而单独放疗组分别为6.7%和0（P〈0.01,P〈0.01）。结论术前同期放化疗有提高肺上沟瘤远期生存率的可能性,虽毒性反应增加,但患者均能耐受,正逐步成为肺上沟瘤新的治疗模式。Background and objective Recently chemoradiotherapy becomes a standard treatment for unresectable advanced non-small cell lung cancer （NSCLC） instead of radiotherapy alone. Superior sulcus tumor of the lung （Pancoast tumor） is a clinical subtype of NSCLC. The aim of this study is to compare the clinical effects and toxicities of preoperative concurrent chemoradiotherapy with radiotherapy alone in patients with superior sulcus tumors. Methods Fifty-six patients with superior sulcus tumors were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy （chemoradiotherapy group）, the other thirty patients received only radiotherapy （radiotherapy group）. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 fraction/5 weeks. For the chemoradiotherapy group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m2 on the 1st day）. Results The rate of complete resection in the chemoradiotherapy group was significantly higher than that in the radiotherapy group （92.3vs 80.0%, P〈0.05） ; The complete pathological response rate and 2-year survival rate in the chemoradiotherapy group were significantly higher than those in the radiotherapy group （P〈0.01, P〈0.01）. The incidences of grade Ⅲ-Ⅳ radiation esophagitis and leukopenia in the chemoradiotherapy group were significantly higher than those in the radiotherapy group （23.1% and 23.1 % vs 6.7 % and 0, P〈0.01, P〈0.01）. Conclusion Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus tumors. It can also increase the acute toxic effect, but all patients can tolerate this treatment regimen, so it might be a new ＂standard treatment＂ for superior sulcus tumor of the lung.

关 键 词：肺上沟瘤 放射治疗 化疗/同步放化疗 

分 类 号：R734.2[医药卫生—肿瘤]