局部晚期非小细胞肺癌同步放化疗的治疗结果  

Outcome of concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer patients

作　　者：刘俪玭 王小震[1] 吉喆[1] 王静波[1] 毕楠[1] 惠周光[1] 吕纪马[1] 梁军[1] 周宗玫[1] 冯勤付[1] 陈东福[1] 张红星[1] 肖泽芬[1] 殷蔚伯[1] 王绿化[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所放疗科,100021

出　　处：《中华肿瘤杂志》2015年第11期863-867,共5页Chinese Journal of Oncology

基　　金：国家自然科学基金（81272616）

摘　　要：目的评价局部晚期非小细胞肺癌（NSCLC）患者同步放化疗的疗效和不良反应。方法2001年1月至2010年12月间初治接受同步放化疗的251例局部晚期NSCLC患者，其中ⅢA期76例，ⅢB期175例。放疗中位剂量为60Gy，其中调强放疗（IMRT）174例，三维适形放疗51例，常规放疗26例。全组患者接受EP方案化疗112例，接受PC方案化疗99例，接受拓扑替康单药化疗18例，接受其他方案化疗22例。分析同步放化疗的疗效及不良反应。结果全组有244例患者可评价近期疗效，其中完全缓解6例（2．5％），部分缓解183例（75．0％），疾病稳定42例（17．2％），疾病进展13例（5．3％）。全组患者中位随访时间20个月，中位生存时间为21个月，其1、3、5年生存率分别为69．2％、31．2％和23．2％。全组患者中位无进展生存时间为10个月，其1、3、5年无进展生存率分别为40．9％、22．1％和17．7％。mA期和ⅢB期NSCLC患者的5年生存率分别为29．2％和20．7％，差异无统计学意义（P=0．133）。全组有244例患者可评价治疗失败模式，其中61例（25．0％）出现局部区域进展，55例（22．5％）出现远处转移，77例（31．6％）出现局部区域进展和远处转移。≥3级放射性肺炎、放射性食管炎及白细胞减少的发生率分别为4．4％、11．2％和26．7％。结论局部晚期NSCLC同步放化疗的疗效较好，不良反应患者可耐受。同步放化疗是不可手术的局部晚期NSCLC的标准治疗方法。Objective To analyze the efficacy and toxicity of concurrent chemoradiotherapy （CCRT） for patients with locally advanced non-small-cell lung cancer （LA-NSCLC）. Methods Clinical data of 251 patients with stage Ⅲ （76 Ⅲ A and 175 Ⅲ B） NSCLC who received CCRT as initial treatment between Jan 2001 and Dec 2010 in our hospital were reviewed. A median total radiotherapy dose of 60 Gy （range, 50-74 Gy） were delivered. 174 patients were treated with IMRT, 51 with 3D-CRT and 26 with 2D- radiotherapy. EP chemotherapy regimen was administered in 112 patients, PC regimen in 99 patients, topoteean regimen in 18 patients and other regimens in the remaining 22 patients. The efficacy and toxicity of CCRT were retrospectively analyzed. Results 244 patiems were assessable for response, including 6 （2.5%） patients with CR, 183（75.0%） with PR, 42 （17.2%） with SD and 13 （5.3%） with PD. At a median follow-up period of 20 months, the 1-, 3-, 5- year OS were 69.2%, 31.2%, 23.2%, respectively, and the median OS was 21 months. The 1-, 3-, 5- year PFS were 40.9%, 22.1%, 17.7%, respectively, and the median PFS was 10 months. Patients with stage m A NSCLC achieved better 5-year OS than that with Ⅲ B NSCLC （29.2% vs. 20.7%, X^2= 2. 254, P = 0. 133）. Failure pattern was assessable in 244 patients, including 61 （ 25.0% ） locoregional progression alone, 55 （22.5%） distant metastasis alone and 77 （31.6%） with both. The rates of grade ≥ 3 radiation pneumonitis, esophagitis and hematologic toxicity were 4.4%,11.2% and 26.4%, respectively. Conclusions CCRT provide stage Ⅲ NSCLC patients favorable outcome with acceptable toxicity. CCRT is standard therapeutic approach for patients with unresectable locally advanced NSCLC.

关 键 词：癌 非小细胞肺 放射疗法 药物疗法 治疗结果 预后 

分 类 号：R734.2[医药卫生—肿瘤]