后程逐量加速超分割放疗同步化疗治疗局部晚期非小细胞肺癌  

Clinical effect of concurrent late-course escalated hyperfractionated accelerated radiotherapy and chemotherapy for locally advanced non-small cell lung cancer

作　　者：杨万毅[1] 陈绪元[2] 

机构地区：[1]重庆市第九人民医院肿瘤科,重庆400700 [2]重庆医科大学附属第一医院,重庆400016

出　　处：《现代肿瘤医学》2009年第5期869-871,共3页Journal of Modern Oncology

摘　　要：目的:评价后程逐量加速超分割放疗同步NP方案化疗治疗局限期非小细胞肺癌的疗效及不良反应。方法:61例局部晚期非小细胞肺癌患者,男41例,女20例;所有患者KPS评分≥70,中位年龄58岁(28-70岁)鳞癌34例,腺癌27例;IIIA期23例,IIIB期38例。采用15MVX线放疗,处方剂量前三周为常规分割放疗2Gy/次,1次/天,大野照射到DT30Gy/15F/3w,然后改为后程逐量加速超分割放疗,第4周1.3Gy/次,2次/天;第5周1.4Gy/次,2次/天;第6周1.5Gy/次,2次/天,两次间隔大于6h以上,总剂量72Gy/45F/6w,脊髓剂量限制在40Gy以下。同步化疗采用NP方案(去甲长春花碱25mg/m2静脉滴入d1、d8,顺铂75mg/m2静脉滴入d1-3,共6个周期)。结果:61例患者全部完成治疗计划,CR29例(47.5%),PR18例(29.5%),NC10例(16.4%),PD4例(6.6%),RR47例(77.1%)。1、2、3年生存率分别为68.8%、34.4%、19.6%;中位生存期18.6个月。急性放射性食管炎发生率67.2%,急性放射性肺炎的发生率为44.2%,均为1-2级。结论:后程逐量加速超分割放疗同期NP方案化疗治疗局限晚期非小细胞肺癌是一种可接受的治疗方案,近期疗效及生存率有所提高、不良反应可以耐受。Objective： To assess curative effects and side reactions or toxicity of late - course escalated hyperfractionated accelerated radiotherapy（LCEHART） delivered concurrently with havobine -cisplatin （NP） scheme chemotherapy for locally advanced non - small cell lung cancer. Methods ： Among 61 patients there were 41 males and 20 females with a median age of 58 （range 35 to 75 ）. Karnofsky scores were 1〉60 for all,34 patients with squamous cell carcinoma,27 adenearcinoma,23 patients in stage ⅢA ,38 ⅢB. 15MV photons was adopted to radiotherapy. In the first, second and third weeks, conventional fraetionated radiotherapy （CF） was used with 2Gy/fraction qd to DT30 Gy/ 15F/3w. LCEHART was used in the next three weeks. In the fourth week 1.3Gy/fraction bid was given,then 1.4 Gy/ fraction bid,in the 5th week, and 1.5 Gy/fraction bid in the 6th week with a 6 hour interval. The total tumor dose was 72 Gy/45F/6w. The spinal cord dosage was limited to 40 Gy. NP scheme chemotherapy was composed of 6 cycles （ navelbine 25mg/m2, on d1, d8, cisplatin 75mg/ m2 on d1 - 3 ）. Results： All 61 patients had finished treatment. Complete response, partial response, stable disease, progressive disease the overall response rates were 29 （47.5%） , 18（29.5% ） ,10（ 16.4% ） ,4（6.6% ） ,47 （67.2%） ,respectively. The 1 - year,2 - year and 3 - year survival rates were 68.8% ,34.4% and 19.6% ,respectively. The median survival time were 18.6 monthes. The radiation - esophagitis, pneumonia rates were 67.2% and 44.2% , respectively. The adverse reaction were below grade 2. Conclusion ： LCEHART delivered concurrently with navobine - cisplatin （NP） scheme for locally advanced non - small cell lung cancer is acceptable ,with a higher short- term curative effect and survival,whereas side reactions are tolerable.

关 键 词：非小细胞肺癌 放射疗法 化学疗法 

分 类 号：R734.2[医药卫生—肿瘤]