摘要
目的探讨化疗联合立体定位（伽玛刀）放疗对中老年晚期复治肺癌的治疗意义。方法收集分析83例Ⅲ、Ⅳ期肺癌复治患者资料（年龄50～81岁），依据再次接受何种治疗方法，分为同步化放疗组（同步组）35例，序贯化放疗组（序贯组）26例，单纯系统化疗组（单化组）22例。放疗均采用体部立体定位放疗装置（伽玛刀）进行，总剂量35—50Gy。联合化疗按肺癌现行常规方案及剂量进行静脉或胸腹腔内化疗，单纯化疗以二、三线调整方案实施；同步组为伽玛刀放疗周期期间同时予以化疗，序贯组为按计划在放疗周期前后间断化疗。结果在各组复治晚期肺癌患者中同步组，序贯组及单化组总有效率（ORR）分别为17．1％、11．5％及31．8％，各组比较无统计学差异（P〉0．05）。Ⅲ期者以同步组略高（23．1％），Ⅳ期患者以单化组较高（38．5％）；但Ⅲ期、Ⅳ期总体有效率相差不大（18．2％，20．0％）。总平均生存期（OS）及中位生存期（MST）以单化组最高，分别为14．2个月及9．3个月；与同步组6．7及6．0个月比较相差明显（P〈0．01），并且序贯组也高于同步组（P〈0．05），95．5％置信区间（CI）不重叠。先前曾行手术治疗患者在后续复治中，不同治疗方式组其生存期均长于非手术者。结论化疗联合伽玛刀放疗同步治疗Ⅲ期复治肺癌患者肿瘤缓解率略高，Ⅳ期患者以单纯化疗有效率高。总平均生存期及中位生存期以系统单纯化疗较高。手术后复治患者生存优势明显。老年复治晚期肺癌后续再次系统化疗是较为合理的有效方法。
Abstract： Objective To investigate the significance of adjuvant chemotherapy and radiotherapy （γ-knife） in the treatment of retreated patients with advance lung cancer. Methods Eighty-three patients（ age 50 to 81 years） with retreating advanced （ Ⅲ/ⅢⅣ stage） c were divided into three groups according to patients received treating by different methods. In all 83 cases, 35 cases were treated by synchronous chemo-radiotherapy （ synchronous group） , 26 cases were treated by sequentially chemo-radiotherapy （ sequentially group） and 22 cases were treated by continuous systematized chemotherapy alone（ chemotherapy group）. The systemic 3- dimensional orientation apparatus was used in radiotherapy. The total dose of 35 - 55 Gy was given in synchronous or sequential chemo-radiotherapy. The chemotherapy regimen in combined radiotherapy was given by common first line regimen on lung cancer. The regimen of chemotherapy about 2 or 3 line was used in chemotherapy group only. Results The overall responses rates （RR） of synchronous, sequentially and chemotherapy groups were 17.1% , 11.5% and 31.8% , but it was non-significance difference respectively between three groups （ P 〉 0.05 ）. The higher effective rate was presented in stage Ⅲ case with synchronous chemo-ra- diotherapy（23.1% ） , and in stage Ⅳ with continuous systematized chemotherapy alone（38.5% ） , but there was non-significance difference in overall responses rates（RR） of Ⅲ/Ⅳ stage groups （ 18.2% and 20.0% ）. The average overall survival time（OS） and median survival time（MST） of the patients treated by chemotherapy were highest about 14.2 and 9.3 months （ respectively in synchronous group 6.7 and 6.0 months ,P 〈 0.01 ） , in which sequentially group was longer than synchronous group（ P 〈 0.05 ） , and 95.5% CI value was not overlap. The total survival time of postoperative patients were longer in the various groups by different treated than that in non-operations. Conclusion The synchronous chemo-radiotherapy can partly increased about RR of the pa- tients with stage Ⅲ case, and higher effective rate was presented in stage Ⅳ with continuous systematized chemotherapy, but the rates（RR） of Ⅲ and Ⅳ stage groups showed non-significance difference. The higher ORR, OS and MST in a few patients of retreated advanced lung cancer was presented in case who was treated by continuous system chemotherapy. The survival superiority in postoperative patients groups was obvious. The systemic chemotherapy was is a reasonable and effect treatment for elderly retreated case with advanced lung cancer.
出处
《临床军医杂志》
CAS
2014年第9期894-897,共4页
Clinical Journal of Medical Officers
关键词
化学治疗
联合放疗
肺肿瘤
chemotherapy
combined radiotherapy
lungtumor
