局部晚期非小细胞肺癌后程加速超分割联合同期化疗的临床观察  

Clinical observation of late course accelerated hyperfractionation radiotherapy combined concurrent chemotherapy for locally advanced non-small-cell lung cancer

作　　者：吴桂平 赵婷婷 张霞 刘小宇 Wu Guiping;Zhao Tingting;Zhang Xia;Liu Xiaoyu(Department of Oncology,Guihang Hospital of Guiyang,Guiyang 550025,China)

机构地区：[1]贵航贵阳医院肿瘤科,贵州贵阳550025

出　　处：《实用肿瘤杂志》2018年第6期560-564,共5页Journal of Practical Oncology

摘　　要：目的探讨后程加速超分割放疗(late course accelerated hyperfractionation radiotherapy,LCAHR)联合同期化疗在局部晚期非小细胞肺癌(locally advanced non-small-cell lung cancer,LANSCLC)中的近期疗效和不良反应。方法选取LANSCLC患者65例,依照数字表法随机分为对照组(n=32,常规分割2. 0 Gy/f,1次/d,5次/周,总剂量66～70 Gy,总治疗时间33～35 d)和研究组(n=33,2个治疗阶段:第1阶段常规分割2. 2 Gy/f,1次/d,5次/周,总剂量57～59 Gy;后进入第2阶段:加速超分割,2. 0 Gy/f,2次/d,8～10次/周,总剂量16～20 Gy;2个阶段累积总剂量73～79 Gy,总治疗时间31～32 d)。两组放疗期间均联合同期化疗,对两组近期疗效、生存时间、不良反应和死亡原因进行比较分析。结果治疗结束随访3～36个月,研究组的治疗总有效率为84. 8%,高于对照组的75. 0%,差异具有统计学意义(P <0. 05)。研究组的1、2、3年生存率分别为54. 5%、30. 3%和18. 2%,高于对照组的40. 6%、18. 8%和9. 4%,差异均具有统计学意义(均P <0. 05)。两组患者的主要不良反应为白细胞、血小板减少以及胃肠道反应、放射性食管炎、放射性肺炎。不良反应发生率两组比较,差异无统计学意义(P> 0. 05)。研究组死亡患者19例,远处转移率24. 2%;对照组死亡25例,远处转移率34. 4%,两组比较差异具有统计学意义(P <0. 05)。结论 LCAHR联合同期化疗治疗LANSCLC近期疗效较好,可提高肿瘤局部控制率,延长患者生存时间,与常规放疗比较并未增加放疗不良反应发生率。Objective To explore the clinical efficacy and toxicity of the late course accelerated hyperfractionation radiotherapy(LCAHR) combined concurrent chemotherapy in locally advanced non-small-cell lung cancer (LANSCLC). Methods Sixty-five patients with LANSCLC were assigned into control group (n =32,conventional radiotherapy:2. 0 Gy/ f,once a day,5 f/w,DT:66-70 Gy,33-35 d) and study group (n =33,two stages:conventional radiotherapy for stage Ⅰ: 2. 2 Gy/f,once a day,5 f/w,DT:57-59 Gy;late course accelerated radiotherapy for stage Ⅱ:2. 0 Gy/f,twice a day,8-10 f/ w,DT:16-20 Gy;altogether,DT:73 ~79 Gy,31 ~32 d). Efficacy,survival time,toxicity and cause of death were compared between the two groups. Results Followed up for 3 to 36 months,the total effective rate of the study group was 84. 8%,significantly higher than 75. 0% of the control group,and the difference was statistically significant (P <0. 05). The 1,2,3 year survival rates of the study group were significantly higher than those of the control group (54. 5%,30. 3% and 18. 2% vs 40. 6%,18. 8% and 9. 4%,all P <0. 05). The main side effects of the two groups were leukocyte reduction,gastrointestinal reaction,esophagitis and radiation pneumonitis. The incidence of side effects in the two groups was not significantly different (P > 0. 05). In the study group,19 patients died,the distant metastasis rate was 24. 2%;25 cases in the control group died,the distant metastasis rate was 34. 4%. The difference between the two groups was statistically significant (P < 0. 05). Conclusion LCHART combined concurrent chemotherapy in the treatment of LANSCLC has better short-term efficacy,can significantly increase the local control rate of tumor;increase the survival time of patients,reduce tumor local recurrence and metastasis,and has less side effects.

关 键 词：癌 非小细胞肺/放射疗法 癌 非小细胞肺/药物疗法 肺肿瘤/放射疗法 肺肿瘤/药物疗法 存活率 放射剂量分次 治疗结果 综合疗法 临床对照试验 

分 类 号：R734.2[医药卫生—肿瘤] R730.55[医药卫生—临床医学]