摘要
目的通过观察在三维适形放疗和同步化疗基础上加上巩固化疗治疗非小细胞肺癌的疗效及毒性,探讨巩固化疗的可行性。方法将106例符合条件的Ⅲ期非小细胞肺癌患者随机分为2组:单纯同步放疗化疗组(对照组)和放疗化疗巩固组(实验组)。放疗采用三维适形技术,针对肺部原发灶及纵隔内≥1cm淋巴结,常规分割2Gy/次,总剂量给予DT:60～66Gy,锁骨上有淋巴结转移者采用6MV-X线加电子线常规分割放疗至总量DT:60～66Gy。化疗全部采用NP方案,单纯同步放化组化疗2周期,放化巩固组共化疗4周期。其中2周期化疗与放射治疗同步进行,分别在放疗开始的第1周与放疗结束的前1周给予;放化巩固组则在同步放化疗之后再另外给予2周期化疗。结果101例患者完成治疗计划。同步放化组与放化巩固组2组的有效率分别为75%,85%。1、2、3年总生存率同步放化组为72%、42%、28%,中位生存期为14.2月;放化巩固组77%、49%、34%,中位生存期为17.9月。1、2、3年局部无进展生存率与中位无复发生存期同步放化组为60%、34%、19%和10.6个月;放化巩固组为68%、38%、25%和12.3个月。急性毒副作用主要有:骨髓抑制、胃肠道反应、急性放射性食管炎、急性放射性气管炎及肺炎,加巩固化疗组的毒副作用明显高于不加巩固化疗组。结论在三维适形放疗和同步化疗基础上加上巩固化疗未能明显提高非小细胞肺癌的生存率。
Objective To investigate the feasibility, efficacy and toxicity of consolidation chemotherapy based on three dimensional conformal radiotherapy and synchronized chemotherapy in patients with non-small cell lung cancer （NSCLC）. Methods 106 patients with stage Ⅲ NSCLC were randomly divided into two groups： consolidation radio-chemotherapy group （study group） and radio-chemotherapy group （control group）. Radiotherapy was given with three-dimensional conformal technology. The total dose was DT：60-66Gy （2Gy/f） for primary lung lesions or mediastinal lymph node （≥1cm）. Metastatic lymph node in supraclavicular region was given 6MV-X combined electron ray by conventional fractionation radiotherapy until the total dose reached DT：60-66Gy. The NP regimen was used for chemotherapy, given in 2 cycles for the control group and in 4 cycles for the study group. The timing of chemotherapy cycles in the control group was the first week and the last week during radiotherapy period. As for the study group, two more cycles were given after synchronized radio-chemotherapy as in the control group. Results 101 patients completed the treatment protocol. 75.4% and 84.9% of the patients in the control group and study group, respectively, responded to the treatment. In the control group,the 1-, 2- and 3-year survival rate was 71.6%, 41.5% and 28.3%, the median length of survival was 14.2 months, the 1-, 2- and 3-year progression-free survival （PFS） rate was 60.3%, 33.9% and 18.8%, and the median relapse-free survival period （RSFP） was 10.6-months. These figures compared with 77.3%, 49.1% and 33.9% for 1-, 2- and 3-year survival rate, 17.9 months for median length, 67.9%, 37.7% and 24.5% for the 1-, 2- and 3-year PFS rates and 12.3 months for RFSP in the study group. The reported acute toxicity events included hone marrow depression, gastrointestinal reaction, acute radiation esophagitis, radiation bronchitis and pneumonia, which seemed to be more frequent with consolidation chemotherapy. Conclusion Consolidation chemotherapy based on three dimensional conformal radiotherapy combined with synchronized chemotherapy may not increase the survival rate for NSCLC patients.
出处
《中国药物与临床》
CAS
2009年第11期1043-1046,共4页
Chinese Remedies & Clinics
基金
山西省卫生厅科技攻关计划项目(200829)
关键词
癌
非小细胞肺/三维适形放射疗法
癌
非小细胞肺/化学疗法
同步放化疗
预后
Carcinoma,NSCLC/three dimensional conformal radiotherapy
Careinoma,NSCLC/Chemotherapy
Synchronized radio-chemotherapy
Prognosis
