摘要
目的探讨后程三维适形放疗加化疗局部Ⅲ期非小细胞肺癌的疗效及患者耐受性.方法 48例患者于治疗前4周行常规分割放疗40Gy,照射野包括原发病灶、同侧肺门和纵隔淋巴引流区.后2周主要针对肿瘤局部行三维适形放疗24～30Gy,4～5Gy/次,3次/周,80%～90%等剂量线包绕PTV并以此为处方线.锁骨上淋巴结转移者用X线和β线混合照射65～70Gy.放疗的第1、5周采用异长春碱25mg/m2第1、8天静脉推注、顺铂30mg第1～3天静脉滴注.结果全部患者均能完成治疗计划,但急性造血系统、胃肠道副作用较重,对症处理后均能耐受.CR率为16.7%,PR率为75.0%,总有效率(CR+PR)为91.7%.1、2、3年局部控制率和生存率分别为87.5%、50.0%、35.7%和87.5%、46.7%、28.6%.结论后程三维适形放疗加化疗局部Ⅲ期非小细胞肺癌有提高总生存率的趋势,但远期生存率和后期并发症尚需进一步观察.
Objective To evaluate the effect and tolerance of late-course three dimensional conformal radiotherapy （LC3DCRT） combined with concurrent chemotherapy for stage Ⅲ non-small cell lung cancer （ NSCLC）. Methods From May 2000 to May 2003, 48 such patients were entered into this study. The patient＇s characteristics were： 38 male and 10 female, with median age of 62 years （range 40 to 74）; Karnovsky performance score ≥ 70; stage Ⅲ A 16 and Ⅲ B 32, squamous cell carcinoma 38 and adenocarcinoma 10. The treatment regimen consisted of conventional radiotherapy first （40 Gy/20f/4W）, followed by 3DCRT （24-30 Gy/4-5f/2W） combined with concurrent chemotherapy. Conventional irradiation field encompassed the primary lesion, ipsilateral hilum and mediastinal lymph drainage region. LC3DCRT focused on the primary lesion only, with the 80%-90% isodose curve covering the planning target volume （PTV） and the target dose was prescribed to PTV. Supraclavicular metastatic lymph node was treated by mixed 6 MV X-ray and electron beam to a total dose of 65-70 Gy. Chemotherapy treatment regimen consisted of isophosfomide （25 mg/m^2, d1,8, iv） and cisplatin （30 mg/d, d1-3, iv ） in the 1st and 5th week. Results Before the end of the second month after treatment , the complete response （CR）and partial response （PR） rate was 16.7% and 75.0%, respectively, with a CR＋ PR rate of 91.7%. The 1-, 2- and 3-year local control and overall survival rates as monitored by the Kaplan-Meier method was 87.5%, 50.0%, 35.7% and 87.5%, 46.7%, 28.6%, respectively.All patients completed the planned treatment without interruption. Hematological toxicity and radiation-induced pneumonitis as shown by the WHO staging system were the most common acute toxicities but they were tolerable, with 8.3% of grade 3 leukopenia and 4.2% of grade 3 radiation-induced pneumonitis. The severity of the other acute toxicities such as nausea, fever, hemoglobin decrease, and radiation-induced esophagitis were mainly grade 1 or grade
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2005年第5期407-409,共3页
Chinese Journal of Radiation Oncology
