全身γ刀联合培美曲塞治疗老年局部晚期肺腺癌临床观察  

Clinical analysis of whole body γ-knife combined with pemetrexed concurrent chemoradiotherapy for the elderly patients with locally advanced lung adenocarcinoma

作　　者：庞军 陈燕 郝光远[2] PANG Jun;CHEN Yan;HAO Guang-yuan(Center of Radiation Oncology , Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646600, P. R. China;Department of Imaging, Hubei Provincial Corps Hospital, Chinese People ＇ s Armed Police Forces, Wuhan 430061 ,P. R. China)

机构地区：[1]西南医科大学附属中医医院肿瘤放疗中心,四川泸州646600 [2]武警湖北总队医院影像科,湖北武汉430061

出　　处：《中华肿瘤防治杂志》2018年第11期807-811,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的同步放化疗已成为局部晚期非小细胞肺癌(local advanced non-small cell lung cancer,LA-NSCLC)的标准治疗方法,但对于老年患者往往难以耐受。本研究旨在探讨全身γ刀联合培美曲塞(pemetrexed,PEM)治疗老年局部晚期肺腺癌的疗效、不良反应及临床应用的可行性。方法选取2013-01-02-2015-12-30武警湖北总队医院37例≥65岁的局部晚期肺腺癌患者,采用超级γ刀(SGS-Ⅰ型)给予放疗,根据患者的身体状况,肿瘤的位置、大小及治疗目的,制定放射治疗计划。以50%~70%的等剂量曲线,给予3.5~5.0Gy的分次处方剂量,周边照射总剂量35~45Gy;同期给予PEM 500mg/m2,静脉滴入,d1,21d为1个周期,治疗≥2个周期。结果 37例患者治疗后中位随访18个月,1、2、3年随访率分别为86.49%(32/37)、59.46%(22/37)和21.62%(8/37),无1例患者失访。治疗结束后2~3个月CT复查,13例(35.14%)完全缓解,22例(59.46%)部分缓解,1例(2.70%)稳定,1例(2.70%)进展,总有效率为94.59%。1年局部控制率为67.57%。1、2、3年生存率分别为86.49%、45.45%和25.00%,中位生存时间17.0个月,95%CI:14.5~21.3个月;无疾病进展中位时间为12.0个月,95%CI:11.6~12.8个月。多因素分析结果显示,淋巴结分期N≥2(P=0.030)和放疗生物有效剂量<60Gy(P=0.010)为总生存期的不利预后因素。大体肿瘤体积(gross tumor volume,GTV)≥120cm3与GTV<120cm3的1年局部控制率分别为62.50%和71.43%,χ2=1.932,P=0.061;中位生存期分别为19和17个月,差异无统计学意义,χ2=0.527,P=0.400。同步放化疗期间Ⅲ~Ⅳ度白细胞减少及血小板减少发生率分别为10.81%(4/37)和5.41%(2/37),2级放射性肺炎及食管炎发生率分别为13.51%和16.22%,无>2级放射性肺炎和食管炎的发生。结论全身γ刀联合PEM治疗老年局部晚期肺腺癌患者疗效确切,不良反应轻微。OBJECTIVE Concurrent chemoradio-therapy（CCRT）has become the standard treatment for local advanced non-small cell lung cancer,but it is often difficult for elderly patients to tolerate.In this study,we evaluated the curative effect,acute radiation reaction and the clinical application of stereotactic radiotherapy with whole bodyγ-knife combined with pemetrexed（PEM）in the elderly patients with local advanced lung adenocarcinoma.METHODS From January 2,2013 to December 30,2015,37 elderly patients with lung adenocarci-noma were treated using stereotactic radiotherapy with Super-γ-knife combined with PEM,The total radiation dose was 35-45 Gy,3.5-5.0 Gy/F（50%-70%isodose line）,1 fraction/d,5 days/w.In the same period,PEM was given 500 mg/m2,d1,intravenous drip,21 das 1 cycle,and the number of cycles was more than 2.RESULTS The follow-up rate was 100%.Among 37 patients,13 cases（35.14%）obtained completely response,22 cases（59.46%）obtained partial response,1 case（2.70%）reached stable status,and 1 case（2.70%）was still in progress,and the total response rate was 94.59%.One year local control rate was67.57%.The overall survival rates of 1,2 and 3-year were 86.49%,45.45% and 25.00%,respectively.The median overall survival（OS）was 17.0 months（95%CI：14.5-21.3 months）;progression-free time was 12.0 months（95%CI：11.6-12.8 months）.Multivariate analysis showed that N≥2 and radiotherapy biological effective dose〈60 Gy were the adverse prognostic indicators of OS（P=0.016 and 0.032,respectively）.One year local control rate and the median survival time were 62.50%,71.43% and 19,17 months respectively between gross tumor volume（GTV）≥120 cm^3 subgroup and GTV〈120 cm^3 subgroup,there were no significant statistical difference（Pvalues were 0.061 and 0.400,respectively）.The incidence rate of grade 3-4 neutropenia and thrombocyto-penia was 10.81%（4/37）and 5.41%（2/37）during the period of CCRT,the grade 2 of incidence of radiation pneumonitis and esophagitis were 13.51% and

关 键 词：全身Γ刀 体部立体定向放射治疗 培美曲塞 老年患者 肺腺癌 

分 类 号：R734.2[医药卫生—肿瘤]