化疗同期胸部三维放射治疗Ⅳ期非小细胞肺癌的可行性研究  

Safety and feasibility of concurrent chemotherapy with thoracic three-dimensional radiotherapy on patients with non-small cell lung cancer at stage Ⅳ

作　　者：张波[1] 卢冰[2] 苏胜发[2] 胡银祥[2] 欧阳伟炜[2] 栗蕙芹[2] 王刚[2] 龙金华[2] 

机构地区：[1]安顺市人民医院肿瘤科,安顺561000 [2]贵阳医学院附属医院胸部肿瘤科(贵州省肿瘤医院肿瘤科)

出　　处：《中国癌症防治杂志》2011年第3期218-222,共5页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：贵州省科技公关项目[黔科合SY(2010)3078号];贵州省科学技术自然基金资助[黔科合J字(2010)2186号]

摘　　要：目的前瞻性研究Ⅳ期NSCLC化疗同期胸内病灶三维放射治疗模式的安全性和可行性。方法 2003年1月至2010年7月入组201例初治IV期非小细胞肺癌(NSCLC);中位年龄60岁;KPS≥70分;化疗以铂类为基础二药联合方案,中位数为3周期。化疗同期原发肿瘤计划靶区剂量(DTPTV)中位数为60.3Gy,转移病灶放疗138例。观察疗程完成情况、化疗和放疗相关毒性。结果 19例仅完成1周期化疗不进行生存分析和评价治疗毒性。完成完整治疗、足量放疗、系统化疗、缺陷治疗和未治疗分别为32%、14%、14.3%、30.3%、9%;4～5周期化疗同期胸部三维放疗DTPTV≥63Gy的中位生存时间为16.1月,较其它治疗的生存期显著延长(χ2=25.369,P=0.000);Ⅱ～Ⅲ级胃肠毒性为45%;Ⅲ-Ⅳ级WBC、PLt、Hb毒性分别为35%、18%、15%;Ⅱ～Ⅲ级放射性肺炎和食管炎分别为9.5%和13.4%。治疗后KPS改善和KPS降低≥10病例的中位生存期分别为12、4月(χ2=78.452,P=0.000),Cox回归分析治疗后KPS变化(P=0.000)对生存有显著影响,性别、年龄、病理类型和胸内病灶剂量差异无统计学意义(P>0.05)。结论化疗同期胸部三维放疗IV期NSCLC的综合治疗模式安全可耐受,4～5周期化疗同期胸部三维放疗DTPTV≥63Gy可能提高生存期,治疗后生存状态降低严重影响生存。Objective To evaluate the safety and feasibility of concurrent chemotherapy with thoracic three-dimensional radio- therapy （TTFDRT） on patients with non-small cell lung cancer （NSCLC） at stage IV. Methods From Jan 2003 to July 2008,201 patients with NSCLC at stage IV entered the study. The median age of the patients was 60 years. All patients received platinum- based chemotherapy ,with the median of 3 cycles. The median radiation dose to PTV of primary tumor was 60. 3Gy ,while 138 pa- tients received TI＇DRT on metastatic foci. The treatment-related gastrointestinal and hematological toxicity were scored. Results 19 patients who received only one cycle of chemotherapy were not included in survival analysis but included in toxicity analy- sis. The rates of patients completed the full treatment, adequate radiotherapy, systemic chemotherapy, defect treatment and no treatment were 32%, 14%, 14. 3% ,30. 3% and 9% ,respectively. The median survival time of patients received 4 to 5 cycles of chemotherapy and DTl, rv t〉 63Gy of TFDRT was 16. 1 months, which was significantly longer than other treatments （ X2 = 25. 369,P = 0. 000）. 45 % of all patients had grade 2 ~ 3 gastrointestinal toxicity. The rates of grade 3 ~ 4 WBC, PLt and Hb toxicity were 35%, 18% and 15% ,respectively. The rates of grade 2 ~ 3 radiation pneumonitis and esophagitis were 9. 5% and 13. 4% respectively. The median survival times of patients with improved KPS and decreased KPS≥ 10 cases after treatment were 12 monlhs and 4 months respeclively （x2= 78. 452,P = 0. 000）. Cox regression analysis showed the improved KPS after tratment was an independent factor for survival （ P = 0. 000）. Conclusions Concurrent chemotherapy with TTDRT on patientswith NSCLC at stage IV is safe and tolerable. 4 to 5 cycles of chemotherapy simultaneously with DTPTV ≥63Gy of TTDRT may improve survival time.

关 键 词：Ⅳ期NSCLC 同期放化疗 三维放射治疗 生存期 KPS 

分 类 号：R734.2[医药卫生—肿瘤]