逐步递量加速超分割照射加化疗非小细胞肺癌  

Escalated hyperfractionated accelerated radiation therapy combined with chemotherapy for non small cell lung cancer

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

机构地区：[1]上海医科大学肿瘤医院放射治疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2000年第1期33-35,共3页Chinese Journal of Radiation Oncology

摘　　要：目的　观察逐步递量加速超分割放射治疗 (EHART)Ⅲb 期非小细胞肺癌 (NSCLC)的近期疗效和急性放射反应。方法　 73例Ⅲb 期NSCLC进入EHART组。放射治疗的第 1,2周 ,1.2Gy 2次 /d间隔 6h以上 ,第 3,4,5周分别为 1.3,1.4,1.5Gy 2次 /d ,均 5天 /周。照射野仅包括胸部CT或MRI可见的原发灶和淋巴结转移灶以及周围 1.0～ 1.5cm的正常组织。肿瘤灶总剂量 6 6Gy ,5 0次 ,5周。放射治疗前化疗 1～ 2个疗程 ,放射治疗后继续化疗 ,总共 4～ 6个疗程。鳞癌或大细胞癌用EP方案 ;腺癌或鳞腺癌用MVP方案。结果　 73例中 12例未完成预定治疗计划。在按计划完成的 6 1例中 ,治疗后体重下降者占 33% (2 0 / 6 1) ;治疗后KPS下降者占 33% (2 0 / 6 1) ;放射性食管炎(RTOG标准 )占 79% (48/ 6 1) ,其中Ⅲ级占 8% (5 / 6 1) ;放射性肺炎占 39% (2 4/ 6 1) ,其中Ⅲ级占 7%(4/ 6 1) ;锁骨上区皮肤急性反应 (湿性脱皮 )占 7% (4/ 6 1)。原发灶完全缓解 (CR)占 10 % (6 / 6 1) ,部分缓解 (PR)占 6 9% (42 / 6 1) ,无变化 +病变进展 (NR +PD)占 2 1% (13/ 6 1) ,总有效率为 79% ;锁骨上淋巴结CR为 5 7% (2 0 / 35 ) ,PR为 40 % (14/ 35 ) ,NR +PD为 3% (1/ 35 ) ,总有效率为 97%。结论　E HART能为大多数Ⅲb 期NSCLC患者耐受 ,有?Objective To assess the immediate responses and acute side effect of escalated hyperfractionated accelerated radiation therapy(EHART) for non small cell lung cancer(NSCLC). Methods From Febuary 1997 to Febuary 1999, EHART was used to treat 73 patients with stageⅢ b NSCLC. Hyperfractionated irradiation was delivered with twice fractions daily (with 6 hours interval) and five treatment days per week . In the first and second weeks, 1.2?Gy/fraction bid was given, then 1.3?Gy/fraction bid, in the 3rd week, 1.4?Gy/fraction bid , in the 4th week, and 1.5?Gy/fraction bid in the 5th week. The total tumor dose was 66?Gy/50fx/5wk. Radiation fields just covered clinical tumors,which were determined by thoracic CT or MRI with 1.0 to 1.5 ?cm margins. Chemotherapy consisted of cisplatin 25～30?mg/m 2 and etoposide 50～70?mg/m 2 on days1,2 and 3,every 4 weeks,for squamous cell carcinoma/large cell carcinoma,while it was composed of mitomycin C 4～6?mg/m 2 on day 1 ,and vindesine 4?mg on days 1 and 8,and cisplatin 25～30?mg/m 2 on days 1,2 and 3,every 4 weeks for adenocarcinoma.Radiotherapy was started on days 4～7.After that,another 3～5 cycles chemotherapy was delivered.Results Twelve patients were excluded from study due to acute complications in 4 cases, distant metastases in 6 cases, and other severe diseases in 2 cases. Therefore,61 cases remained was further analyzed to evaluate acute complications and immediate responses. Acute radiation esophagitis occurred in 71% of patients with Grade Ⅰ～Ⅱ(RTOG), and 8% with Grade Ⅲ . Acute radiation pneumonitis occurred in 32% of patients with Grade Ⅰ～Ⅱ(RTOG), and 7% with Grade Ⅲ. The overall response rate(CR+PR) was 79%(48/61) for pulmonary primary tumor, and 97%(34/35) for metastatic supraclavicular nodes.Conclusions EHART could be tolerated by most of the patients with stage Ⅲ b NSCLC. The immediate response of tumor is encouraging.

关 键 词：非小细胞肺癌 放射疗法 逐步递量 加速超分割 

分 类 号：R734.2[医药卫生—肿瘤]