化疗配合立体定向放疗在中晚期复治肿瘤治疗中的作用分析  

Analysis of efficacy of chemotherapy combined with stereotaxic radiotherapy in re-treating advanced cancer

作　　者：虞喜豪[1] 李新娉[1] 董桂云[1] 熊茑[1] 王建平[1] 虞文嫣[2] 

机构地区：[1]解放军第八五医院肿瘤病区,上海200052 [2]上海交通大学医学院基础医学部

出　　处：《中国肿瘤临床与康复》2011年第3期258-261,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨及评价化疗联合立体定位放疗,在晚期复治恶性肿瘤治疗中的作用意义。方法 196例患者依据接受主要治疗方法,分为同步化放疗组75例,序贯化放疗组49例,单纯系统化疗72例。放疗均采用体部立体定位放疗装置（伽玛刀）进行,总剂量35~50 Gy。化疗依据不同肿瘤按现行常规方案及剂量进行静脉或胸腹腔内化疗。同步组为伽马刀放疗周期期间同时予以化疗,序贯组为按计划在放疗周期前后进行化疗。结果在各类复治晚期肿瘤患者中同步组、序贯组及单纯化疗组总有效率（ORR）分别为20.0%、14.3%及26.9%（P〉0.05）。各组中鼻咽癌及淋巴癌有效率较高于其他肿瘤;肺癌以系统化疗组较高（31.8%）,而胰腺癌则以同步放化疗者较高（20%）,与其他二组比较差异有显著性。各类肿瘤总平均生存期及中位生存期以单纯系统化疗组最高,分别为14.5个月及10.2个月（与同步化疗组比t=5.06,P〈0.05）,并且序贯放化疗组高于同步治疗组。不同肿瘤在三组治疗中生存期仍表现为消化系肿瘤最长,肺癌其次,胰腺癌较短。手术后患者经不同治疗生存期长于非手术者。较严重（Ⅲ~Ⅳ度）白细胞减少发生率以单纯系统化疗最高,为12.5%。结论同步化放疗可提高部分肿瘤（如胰腺癌）的有效率并且不增高毒副反应,但总平均生存期及中位生存期以系统单纯化疗较高。故复治晚期肿瘤规范系统化疗是较为合理有效的方法。Objective To investigate the efficacy and significance of chemotherapy combined with stereotaxic radiotherapy（Gamma-knife） in re-treating patients with advanced cancer.Methods 196 patients with advanced recurrent cancer were divided into three groups according to different methods of treatment： 75 cases were treated with synchronous chemoradiotherapy（group A）,49 cases with sequential chemoradiotherapy（group B） and 72 case,with continuous systematized chemotherapy alone（group C）.The systemic 3-dimensional orientation apparatus was used for radiotherapy.The total dose of 30-50 Gy was given in synchronous or sequential chemoradiotherapy.The chemotherapy regimen in combination with radiotherapy was given at conventional dose of first line treatment according to different tumors.The regimen of 2nd or 3rd line chemotherapy was used in group C.Results The overall response rates（oRR） of groups A,B and C were 21.3%,14.3% and 26.9%,respectively,with no significant difference（P0.05）.The high effective rate was presented in nasopharyngeal cancer and lymphoma in all groups.The RR of lung cancer was high（31.8%） in group C and pancreatic cancer was 20.0% in group A.The average overall survival time（OS） and median survival time（MST） of the patients treated with chemotherapy（group C） were the highest being 14.5 and 10.2 months（P0.05,compared with group A）,those of group B were longer than those of group A（P0.05）.The survival time was longer in digestive tract tumor than in lung and pancreatic cancer in different treatment groups.The total survival time of postoperative patients was longer in various tumor patients treated with different methods than in non-operations patients.The rate of serious hematological side-effect（degree 3 or 4 neutropenia） was highest in systematic chemotherapy group,being 12.5%.Conclusion The synchronous chemoradiotherapy can increase oRR of some tumors without increasing side effects.The oRR,OS and MST were highest in patients treated with continuous

关 键 词：联合放疗 肿瘤/化学疗法 

分 类 号：R730.53[医药卫生—肿瘤] R730.58[医药卫生—临床医学]