摘要
目的探讨放疗结合紫杉醇或(和)卡铂同步化疗局部晚期非小细胞肺癌的副反应和疗效。方法41例Ⅲ期非小细胞肺癌患者(Ⅲa期17例,Ⅲb期24例)接受D_T60～70 Gy放疗,疗中给予45mg/m^2紫杉醇(13例)或合用卡铂AUC=2(28例),1次/周给药,共4～6周,放化疗在同一天开始进行。结果37例患者完成了60～72 Gy放疗,2例放疗总量54 Gy,2例56 Gy。38例完成了4～6周化疗,3例完成了2周化疗。≥3级骨髓抑制2例,3级放射性食管炎4例,≥2级放射性肺炎6例,3级黏膜炎1例。全组总有效率(CR+PR)78%。中位随访期17．2个月,中位生存期16．5个月,1、2、3年生存率分别为69%、34%和34%。放疗剂量＞66 Gy与≤66 Gy的中位生存期分别为13．2、36．8个月(P=0．027)。中位无局部复发生存期57．8个月,1、2年无局部复发生存率分别为85%、85%。失败原因照射野内复发4例,照射野外1例,照射野内+野外1例,癌性胸水2例,远处转移12例。结论紫杉醇或(和)卡铂同步放化疗局部晚期非小细胞肺癌患者副反应可接受,具有较好的近期和远期疗效,失败原因主要为远处转移。放疗剂量高者疗效较好。
Objective To study the toxicity and efficacy of concurrent paclitaxel or/and carboplatin with radiotherapy for stage Ⅲ non-small cell lung cancer（NSCLC）. Methods Forty-one patients pathologically diagnosed as suffering from NSCLC（ Ⅲa ： 17 , Ⅲb ： 24 ） received concurrent 60-70 Gy conventional fractionated external beam radiotherapy with chemotherapy： paclitaxel（45 mg/m^2, n = 13） ; or combined with carboplatin（ AUC = 2, n = 28）, once weekly. Results Thirty-seven patients received a total dose of 60-72 Gy, two received 54 Gy and two received 56 Gy. Thirty-eight patients received 4-6 weeks of chemotherapy, while three patients received only 2 weeks of chemotherapy. Two patients experienced grade 3 and 4 neutropenia, 4 grade 3 radiation esophagitis, 6 t〉 grade 2 radiation pneumonitis and one grade 3 mucositis. The total response rate（ CR ＋ PR） was 78%, with a median follow-up time of 17.2 months.The median survival time was 16.5 months（20.0 Ⅲ for stage Ⅲa, 15.8 m for Ⅲb,） .The overall 1-, 2- and 3-year survival rate was 69% ,34% and 34%, respectively. The median time of recurrence-free survival was 57.8 months. The 1- and 2-year recurrence-free survival（RFS） rate was 85% and 85%, respectively. The patterns of failure were 4 intra-field recurrence, 1 local and extra-field regional recurrence, 1 extra-field regional recurrence, 2 carcinomatous pleural effusion and 12 distant metastasis. Concurrent chemoradiotherapy with paclitaxel and/or carboplatin can well be tolerated, with a relatively good short and remote effectiveness. The major pattern of failure is distant metastasis. High radiation dose （ 〈 66 Gy） may provide a more satisfactory powerful effectiveness.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2006年第4期270-274,共5页
Chinese Journal of Radiation Oncology
关键词
癌
非小细胞肺/放射疗法
癌
非小细胞肺/化学疗法
紫杉醇
卡铂
预后
Carcinoma, non-small cell lung/radiotherapy
Carcinoma, non-small cell lung/ chemotherapy
Paclitaxel
Carboplatin
Prognosis
