恩度联合同期放化疗治疗不可切除Ⅲ期非小细胞肺癌不良反应的观察与护理  

Adverse reactions and management in Endostar combined with concurrent chemoradiotherapy for inoperable stage Ⅲ non-small cell lung cancer

作　　者：沈佳琴[1] 邵秋月[1] 叶英俊[1] 王谨[1] 马红莲[1] 徐裕金[1] 胡晓[1] 陈明[1] 谢淑萍[1] SHEN Jia-Qin SHAO Qiu-Yue YE Ying-jun et al(Department of Radiation Oncology , Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310015, China)

机构地区：[1]浙江省肿瘤医院放疗科,浙江杭州310015

出　　处：《中华全科医学》2017年第10期1805-1807,共3页Chinese Journal of General Practice

基　　金：浙江省自然科学基金重点项目(LZ13H160003);浙江省自然科学基金青年基金项目(LQ14H160005)

摘　　要：目的观察重组人血管内皮抑制素(商品名恩度)联合放化疗治疗不可切除Ⅲ期非小细胞肺癌的不良反应,为新模式治疗提供理论依据。方法将2013年11月—2015年1月浙江省肿瘤医院符合研究入组标准的23例不可切除Ⅲ期非小细胞肺癌患者,在治疗的第1、3、5、7周接受恩度(每天7.5 mg/m^2)持续泵注5 d;第2周开始接受6~7周的三维适形或适形调强放疗60~66 Gy/30~33 Fr;放疗同期依托泊苷50 mg/m^2d_(1~5),d_(29~33),加顺铂50 mg/m^2d_(1、8、29、36)。根据CTCAE 3.0评估患者治疗不良反应的发生情况。期间做好放化疗护理,并对不良反应进行有效的护理干预。结果 23例患者均完成治疗及疗效评价。放疗剂量<60、60~66 Gy分别为3、20例。主要不良反应Ⅲ、Ⅳ级中性粒细胞减少14例(60.9%),Ⅲ、Ⅳ级贫血4例(17.4%),Ⅲ、Ⅳ级血小板减少8例(34.8%)。Ⅲ级恶心/呕吐2例(8.7%),Ⅰ级放射性肺炎1例(4.3%),Ⅲ级放射性食管炎1例(4.3%),低血压6例(26.1%),心律失常1例(4.3%),无出血及治疗相关死亡事件发生。结论恩度泵注给药提高了患者的依从性,联合同期放化疗不可切除Ⅲ期NSCLC近期疗效和耐受性良好,治疗期间做好全方面的护理干预,可以减轻患者的不良反应、提高患者依从性,改善患者的生活质量。Objective To observe the adverse reactions of recombinant human endostatin（Endostar） combined with chemoradiotherapy in the treatment of unresectable stage m non-small cell lung cancer, and to provide theoretical basis for the new treatment. Methods The clinical data of 23 patients with inoperable locally advanced non-small cell lung cancer in our hospital from November,2013 to January,2015 were reviewed. The patients received Endostar[ 7.5 mg/（ m2 · d） ] by 5 days continuous infusion at weeks 1,3,5 ,and 7 ,while two cycles of etoposide（50 mg/m2） at dI to d~ and cisplatin （50 mg/m2） at d1 and ds were administered at weeks 2 and 6 with concurrent three-dimensional eonformal or intensity modulated conformal radiotherapy to a dose of 60 - 66 Gy. Toxicity was evaluated according to CTCAE 3.0. Nursing care and intervention were given when necessary during radiotherapy and chemotherapy. Results The treatment and clinical evaluation were conducted in all 23 patients, the main adverse reactions included low white blood cell count in 14 cases （ grade 3 and 4,60.9% ）, anemia in 4 cases （ grade 3 and 4,17.4% ）, low blood platelet count in 8 cases （ grade 3 and 4, 34.8 % ）, radiation pneumonia in 1 case （ grade 1,4.3 % ）, radiation esophagitis in 1 case （ grade 3,4.3 % ）, hypotension in 6 cases （26.1% ）, and arrhythmia in 1 case （4.3 % ）. There were no renal disorder, bleeding or coagulation disorders, and treatment-related death. Conclusion Endostatin infusion administration can improve the compliance of patients. The short term outcome and tolerability of Endostar combined with concurrent chemoradiotherapy for unresectable stage llI non-small cell lung cancer are good, it can reduce the toxicity, increase compliance and improve quality of life of patients.

关 键 词：血管内皮抑制素 肺癌 不良反应 观察 

分 类 号：R734.2[医药卫生—肿瘤]