逐步递量加速超分割放射治疗联合化疗治疗ⅢB期非小细胞肺癌  

Escalated hyperfractionated accelerated radiation therapy combined with chemotherapy for stage ⅢB non-small cell lung cancer

作　　者：赵丽华[1] 张帆[1] 吴红宇[1] 吴琼雅[1] 贺晓东[1] 

机构地区：[1]上海市肺科医院放疗科,200433

出　　处：《中国肺癌杂志》2002年第6期420-422,共3页Chinese Journal of Lung Cancer

摘　　要：目的　研究逐步递量加速超分割放射治疗 (EHART)对ⅢB期非小细胞肺癌 (NSCLC)的近期疗效和急性放射反应。方法　 1998年至 2 0 0 1年间 ,112例符合纳入标准的患者进入本研究 ,非随机分为常规放疗组 (CFRT 65例 )和EHART组 (4 7例 )。CFRT组 :1.8～ 2Gy/次 /天 ,5天 /周 ,肿瘤中心总剂量 5 4～ 70Gy/2 7～ 40次 /3 7～ 85天 ,中位剂量 60Gy/3 0次 /4 3天 ;EHART组 :第 1、2周为 1.2Gy/次 ,2次 /天 ,间隔 6h以上 ,第 3、4、5周分别为 1.3、1.4、1.5Gy/次 ,2次 /天 ,均 5天 /周 ,总剂量为 60～ 66Gy/4 6～ 5 0次 /3 0～ 45天 ,中位剂量 66Gy/5 0次 /3 4天。照射野均包括胸部CT可见的病灶及周围 1.5cm的正常组织。放疗前化疗 1～ 2个周期 ,放疗结束后继续化疗 ,共计 4～ 6个周期 ,所用方案多数为MVP方案 (M :丝裂霉素 ,V :长春地辛 ,P :顺铂 )。患者均随访满 1年。结果　EHART组和CFRT组各有 7例和 12例患者未完成治疗计划。在按计划完成治疗的 93例患者中 ,两组的有效率分别为 72 .5 %和 64 .2 % ,1年生存率分别为 60 .0 %和 47.2 % ,局控率分别为 67.5 %和 5 2 .8% ,两组间比较均无显著性差异 (P >0 .0 5 )。EHART组急性放射性食管炎发生率及严重度高于CFRT组 (P=0 .0 2 5 )。结论　EHART联合化疗治疗ⅢB?Objective To evaluate the therapeutic effect and acute side effect of escalated hyperfractionated accelerated radiation therapy (EHART) combined with chemotherapy for stage ⅢB non small cell lung cancer (NSCLC). Methods From Aug. 1998 to Aug. 2001, a prospective trial for NSCLC was carried out in 112 patients with stage ⅢB. These patients were nonrandomly divided into 2 groups: conventional fractionated radiation therapy group (CFRT 65 cases) and EHART group (47 cases). The CFRT patients were treated by 1.8 2 Gy/fraction per day, 5 treatment days per week; the total doses received in center of tumor were 54 70 Gy /27 40 fractions/37 85 days, the median was 60 Gy/30 factions/43 days. The EHART patients were treated by escalated doses: In the first and second weeks, 1.2 Gy/fraction twice a day was given, then 1.3 Gy , 1.4 Gy , and 1.5 Gy from third to fifth weeks respectively, twice fractions a day (over 6 hours interval), 5 treatment days each week, the total doses were 60 66 Gy/46 50 fractions/30 45 days, the median was 66 Gy /50 fractions/34 days. Radiation fields just covered the tumor mass which were determined by thoracic CT with 1.5 cm margins. A total of 4 6 cycles chemotherapy with MVP regimen mostly was delivered before (1 2 cycles) and after (3 5 cycles) radiotherapy. Each patient was followed up for 1 year. Results Seven cases were excluded from EHART, twelve from CFRT. There were 93 patients to be evaluated. The immediate response rate of tumor by EHART and CFRT was 72.5% and 64.2% respectively (χ 2=1.02, P=0.346). The 1 year survival rate was 60.0% and 47.2% respectively (χ 2=2.56, P=0.107), and the local control rate was 67.5% and 52.8% respectively (χ 2=3.01, P=0.085). The incidence and degree of acute radiation esophagitis in EHART were more severe than that in CFRT (χ 2=5.02, P=0.025). Conclusion The treatment effect by EHART for stage ⅢB NSCLC is encouraging and its toxicities could be tolerated by most of patients. It is wort

关 键 词：ⅢB期非小细胞肺癌 非小细胞肺癌 放射疗法 逐步递量加速超分割放射治疗 药物疗法 NSCLC 

分 类 号：R734.2[医药卫生—肿瘤]