老年非小细胞肺癌立体定向体部放疗联合化疗的临床观察  

Satereotactic body radiation therapy combined with chemotherapy on aged patients with non-small cell lung cancer

作　　者：陈亚平 姜晓晓 冯守信[3] 韩正祥[4] 杜秀平[4] 蒋冠[5] 

机构地区：[1]盐城市第一人民医院肿瘤科,江苏盐城224000 [2]盐城市第一人民医院泌尿外科,江苏盐城224000 [3]徐州医学院附属医院立体定向放疗科,江苏徐州221000 [4]徐州医学院附属医院肿瘤科,江苏徐州221000 [5]徐州医学院江苏省肿瘤生物治疗重点实验室,江苏徐州221000

出　　处：《中华肿瘤防治杂志》2015年第22期1779-1782,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：江苏省卫生厅医学科技发展基金会临床肿瘤学科研项目(P200942)

摘　　要：目的立体定向体部放疗、化疗是治疗老年非小细胞肺癌（non-small cell lung cancer，NSCLC）主要方法，立体定向体部放疗联合化疗是新的治疗模式。本研究观察立体定向体部放疗联合化疗治疗老年NSCLC患者治疗的临床疗效和不良反应。方法选取2011-06—01—2012-06—20徐州医学院附属医院48例ⅢB和Ⅳ期NSCLC的老年初治患者，随机数字表法分为治疗组23例和对照组25例。治疗组应用立体定向体部放疗联合化疗，对照组应用单纯立体定向体部放疗。立体定向体部放疗采用50％周边剂量3．0～4．0Gy／次，总剂量45．0-48．0Gy，1次／d，每周5次。化疗采用吉西他滨800mg／（m^2·d），持续静脉滴入0．5h，d1、d8。顺铂25mg／（m^2·d），静脉滴入，d1～d3。每3周重复，共3～4个周期。对2组患者治疗后的有效率、生活质量KPS评分、1和2年生存率以及不良反应进行比较分析。结果治疗组和对照组患者有效率分别为87％（20／23）和60％（15／25），差异有统计学意义，χ^2=4．408，P=0．036；生活质量评分改善率分别为74％（17／23）和40％（10／25），差异有统计学意义，χ^2=5．598，P=0．018；1年生存率分别为61％（14／23）和32％（8／25），χ^2=4．022，P=0．045；2年的生存率分别为39％（9／23）和12％（3／25），χ^2=4．703，P=0．030；中位生存时间分别为14和7个月，χ^2=8．520，P=0．04；患者放射性肺炎发生率分别为35％（8／23）和20％（5／25），χ^2=1．326，P=0．25；放射性肺纤维化发生率分别为17％（4／23）和12％（3／25），χ^2=0．279，P=0．597；其他不良反应经对症处理后均可耐受。结论采用立体定向体部放疗联合化疗治疗老年NSCLC，可提高患者近期有效率，改善生活质量，提高1、2年生存率及中位生存时间，且耐受性较好。OBJECTIVE Stereotactic body radiation therapy （SBRT） and chemotherapy was the main treatments on aged patients with non-small-cell lung cancer （NSCLC）. SBRT combined with chemotherapy is a new treatment on aged patients with NSCLC. Our study is to evaluate the clinical efficacy and side-effective of SBRT combined with or without chemotherapy on aged patients with NSCLC. METHODS Patients in the affiliated hospital of xuzhou medical college be- tween June 2011 to June 2012 were randomly assigned to the experimental group with 23 patients involving SBRT combined with chemotherapy,or to the control group with 25 patients receiving SBRT only. SBRT was used in a 50% body portion surrounding of 3.0-4.0 Gy each dose and 45.0-48.0 Gy in total,once a day,five times a week. Gemcitabine （800 mg/m^2/d,intravenously 0. 5 h, d1 , d8 ） plus Cisplatin （25 mg/m^2/d, intravenous infusion, d1- d3 ） were used as chemotherapy. The response rate,quality of life KPS, 1-year and 2-year survival,median survival time and incidences of adverse events were compared between two groups of the patients after treatment. RESULTS The response rate were 87 % （20/23） and 60%（15/25） between the experimental group and the control group（χ^2 = 4. 408, P = 0. 036 ）. The quality of life improvement rate were 74%（17/23） and 40% （ 10/25）, respectively（χ^2= 5. 598, P= 0. 018）. The 1-year survival rate in the experimental group were 61%（14/23） and 32%（8/25）, respectively（χ^2= 4. 022, P = 0. 045 ）, and 2-year surviv al rate in the control group were39%（9/23） and 12%（3/25）,respectively（χ^2=4.703,P=0.030）. The median survival time were 14 months and 7 months for the two groups （χ^2=8. 520,P=0.04）. Incidences of radio pneumonitis were 35%（8/23） and 20%（5/25） ,respectively（χ^2= 1. 326, P= 0.25）, and incidences of pulmonary fibrosis were 17%（4/23） and 12%（3/25）, respectively（χ^2= 0. 279, P= 0. 597）. There was no statistically significance between two groups on adverse

关 键 词：立体定向体部放疗 化疗 非小细胞肺癌 临床观察 

分 类 号：R734.2[医药卫生—肿瘤]