中老年晚期复治肺癌患者中化疗配合立体放疗的作用分析  

Analysis on adjuvant chemotherapy and γ-knife radiotherapy in retreated elderly patients with advanced lung cancer

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

机构地区：[1]解放军第85医院肿瘤病区,上海200052 [2]上海交通大学医学院基础医学部,上海200025

出　　处：《临床军医杂志》2014年第9期894-897,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨化疗联合立体定位（伽玛刀）放疗对中老年晚期复治肺癌的治疗意义。方法收集分析83例Ⅲ、Ⅳ期肺癌复治患者资料（年龄50～81岁），依据再次接受何种治疗方法，分为同步化放疗组（同步组）35例，序贯化放疗组（序贯组）26例，单纯系统化疗组（单化组）22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—50Gy。联合化疗按肺癌现行常规方案及剂量进行静脉或胸腹腔内化疗，单纯化疗以二、三线调整方案实施；同步组为伽玛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间断化疗。结果在各组复治晚期肺癌患者中同步组，序贯组及单化组总有效率（ORR）分别为17．1％、11．5％及31．8％，各组比较无统计学差异（P〉0．05）。Ⅲ期者以同步组略高（23．1％），Ⅳ期患者以单化组较高（38．5％）；但Ⅲ期、Ⅳ期总体有效率相差不大（18．2％，20．0％）。总平均生存期（OS）及中位生存期（MST）以单化组最高，分别为14．2个月及9．3个月；与同步组6．7及6．0个月比较相差明显（P〈0．01），并且序贯组也高于同步组（P〈0．05），95．5％置信区间（CI）不重叠。先前曾行手术治疗患者在后续复治中，不同治疗方式组其生存期均长于非手术者。结论化疗联合伽玛刀放疗同步治疗Ⅲ期复治肺癌患者肿瘤缓解率略高，Ⅳ期患者以单纯化疗有效率高。总平均生存期及中位生存期以系统单纯化疗较高。手术后复治患者生存优势明显。老年复治晚期肺癌后续再次系统化疗是较为合理的有效方法。Abstract： Objective To investigate the significance of adjuvant chemotherapy and radiotherapy （γ-knife） in the treatment of retreated patients with advance lung cancer. Methods Eighty-three patients（ age 50 to 81 years） with retreating advanced （ Ⅲ/ⅢⅣ stage） c were divided into three groups according to patients received treating by different methods. In all 83 cases, 35 cases were treated by synchronous chemo-radiotherapy （ synchronous group） , 26 cases were treated by sequentially chemo-radiotherapy （ sequentially group） and 22 cases were treated by continuous systematized chemotherapy alone（ chemotherapy group）. The systemic 3- dimensional orientation apparatus was used in radiotherapy. The total dose of 35 - 55 Gy was given in synchronous or sequential chemo-radiotherapy. The chemotherapy regimen in combined radiotherapy was given by common first line regimen on lung cancer. The regimen of chemotherapy about 2 or 3 line was used in chemotherapy group only. Results The overall responses rates （RR） of synchronous, sequentially and chemotherapy groups were 17.1% , 11.5% and 31.8% , but it was non-significance difference respectively between three groups （ P 〉 0.05 ）. The higher effective rate was presented in stage Ⅲ case with synchronous chemo-ra- diotherapy（23.1% ） , and in stage Ⅳ with continuous systematized chemotherapy alone（38.5% ） , but there was non-significance difference in overall responses rates（RR） of Ⅲ/Ⅳ stage groups （ 18.2% and 20.0% ）. The average overall survival time（OS） and median survival time（MST） of the patients treated by chemotherapy were highest about 14.2 and 9.3 months （ respectively in synchronous group 6.7 and 6.0 months ,P 〈 0.01 ） , in which sequentially group was longer than synchronous group（ P 〈 0.05 ） , and 95.5% CI value was not overlap. The total survival time of postoperative patients were longer in the various groups by different treated than that in non-operations. Conclusion The synchr

关 键 词：化学治疗 联合放疗 肺肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]