适形调强放疗联合EGFR-TKI治疗晚期非小细胞肺癌的临床观察  

Three-dimensional conformal radiotherapy(3D-CRT)or intensity-modulated radiotherapy(IMRT)combined with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)for patients with advanced non-small cell lung cancer

作　　者：郑国平[1] 王思本[1] 李岱[1] 严森祥[2] 朱胜裕[1] 熊中奎[1] 

机构地区：[1]绍兴第二医院肺部肿瘤诊疗中心,312000 [2]浙江大学医学院附属第一医院放疗科

出　　处：《浙江医学》2015年第6期473-476,共4页Zhejiang Medical Journal

摘　　要：目的 评价适形调强放疗联合表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗晚期非小细胞肺癌（NSCLC）的疗效和不良反应.方法 42例初治或复发的ⅢB～Ⅳ期NSCLC患者,采用三维适形或调强放疗,范围包括原发灶及转移灶.肺原发灶剂量40～60 Gy/20～30次,脑转移灶先行全脑放疗30Gy/10次（或40 Gy/20次）,再缩野加量9Gy/3次（或20Gy/10次）;骨转移灶放疗30 Gy/10次或40 Gy/20次.自放疗第1天起开始服EGFR-TKI（埃克替尼125mg,2次/d;或吉非替尼250 mg,1次/d;或厄洛替尼150mg,1次/d）,直至疾病进展或出现不可耐受的不良反应.放射治疗结束1个月后评价疗效及不良反应.结果 42例患者有效率和疾病控制率分别为28.6％（12/42）、64.3％（27/42）;中位疾病进展时间（MTTP）8.1个月,中位生存期（MST）15.5个月.1年和2年生存率分别为58.6％和12.3％.毒副反应以Ⅰ～Ⅱ级为主,Ⅲ级不良反应有皮肤的痤疮样皮疹及皮肤搔痒,粒细胞减少、腹泻、食欲减退、贫血,无Ⅲ级放射性肺炎及食管炎发生.结论 采用适形或调强放疗联合EGFR-TKI治疗晚期非小细胞肺癌治疗有较好的近期疗效及生存,不良反应轻微,多数患者能耐受治疗.Objective To evaluate the efficacy and safety of three-dimensional conformal radiotherapy （3D-CRT） or in- tensity-modulated radiotherapy （IMRT） combined with epidermal growth factor receptor tyrosine kinase inhibitors（ EGFR-TKIs ）for patients with advanced non-small cell lung cancer （NSCLC）. Methods Forty two patients with initial or relapse IIIB-IV stage NSCLC received 3D-CRT or IMRT on primary and metastatic lesions. Radiation dose for thoracic primary lesions was 40-60 Gy/20-30 fractions; and whole brain radiotherapy（WBRT） was administered at a dose 30Gy/10 fractions （or 40 Gy/20 fractions） for brain metastasis, then boost to 9Gy/3 fractions （or 20Gy/10 fractions）; the dose for bone metastasis was 30 Gy（10 fractions） or 40 Gy（20 fractions）. From d l of treatment, patients took EGFR-TKIs（ Icotinib 125mg, bid; or gefitinib 250 mg, qd;or erlotinib150mg, qd ）till tumor progression or unacceptable toxicities. After one month the efficacy and adverse reaction of the treatment were evaluated. Results In 42 cases, the response rate was 28.6% （12/42） and the disease control rate was 64.3% （27/42）. Median time to tumor progression （MTTP） was 8.1m; median survival time （MST） was 15.5m. The 1-y and 2-y survival rates were 59.6% and 12.3% respectively. The main toxicities were I-II level, and the III level reactions included ache-like rashes and pruritis, granulo-cytopenia, diarrhea, loss of appetite, anemia; however radiation pneumonitis or esophagitis were not observed. Conclusion CRT or IMRT combined with EGFR-TKIs is safe and effective for patients with advanced or metastatic NSCLC.

关 键 词：非小细胞肺癌 适形调强放疗 靶向治疗 表皮生长因子受体酪氨酸激酶抑制剂 

分 类 号：R734.2[医药卫生—肿瘤]