摘要
目的观察诱导化疗和三维适形放疗（3DCRT）联合每周紫杉醇治疗非小细胞肺癌（NSCLC）的疗效及毒性。方法56例不能手术的Ⅲ期NSCLC患者予紫杉醇（175mg／m^2第1天）加卡铂（AUC=5～6第1天）诱导化疗2—4个疗程，化疗后3～4周内开始3DCRT，剂量在满足V20≤31％，脊髓≤50Gy的条件下给予尽可能高（平均60．75Gy），联合每周紫杉醇40mg／m^2同期化疗。结果同期放化疗期间，3例因3＋4级放射性肺炎，1例因3级心脏毒性终止治疗，2例因身体虚弱分别中断治疗7、12d，其余均按计划完成治疗。白细胞下降发生率为58．9％（1例为3级，余为1、2级），3级淋巴细胞下降发生率达75．0％。主要急性毒性为放射性食管炎和放射性肺炎，≥2级发生率分别为38％和25％。放射性食管炎3级3例，放射性肺炎3级2例，4级1例。2、3、4级晚期食管损伤各1例，肺纤维化2级9例。肺原发灶总有效率为69．7％。1年生存率分别为72．3％，1年局部无进展生存率为62．7％。局部复发率为32．1％，远处转移率为39．3％，远处转移与局部复发仍是死亡的主要原因。结论诱导化疗后3DCRT结合每周紫杉醇治疗局部晚期NSCLC耐受性较好，近期疗效好，远期疗效有待继续观察。
Objective To evaluate the toxicity and efficacy of induction chemotherapy （ICT） followed by three-dimensional conformal radiotherapy（3DCRT） plus concurrent weekly paclitaxel for inoperable non-small cell lung cancer （ NSCLC ）. Methods Patients with stage m NSCLC in favorable conditions were treated with 2 to 4 cycles of carboplatin（ AUC =5-6,d1 ） combined with paclitaxel（ 175 mg/m^2 ,d1 ）, then followed by weekly paclitaxel（40 mg/m^2） and concurrent 3DCRT within 3-4 weeks. The prescription dose of radiotherapy was given as high as possible while total lung V20 ≤31% and total dose of the spinal cord ≤50 Gy. Results ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 4 patients was ended ahead of the schedule because of severe pulmonary and cardiac toxicities;the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Leucopenia（33/56） was in grade 1-2 except 1 patient in grade 3. Lymphocytopenia was severe（54/56,42 in grade 3 ）. Three patients developed grade 3 acute radiation-induced esophagitis, and 3 developed grade 3-4 radiation-induced pneumonitis. There was one patients each who developed grade 2,3, and 4 late esophageal damage, respectively. Nine developed grade 2 pulmonary fibrosis. The overall response rate was 69.7%. The 1-year overall survival rate was 72.3%. The 1-year local progression-free survival rate was 62.7%. Conclusions The schedule of ICT followed by weekly paclitaxel and concurrent 3DCRT can be well tolerated by most of the favorable patients with stage Ⅲ NSCLC, and the toxicity is tolerable. Results of this study are encouraging, though long-term results should be followed up.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2008年第4期252-256,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
疗效
Carcinoma, non-small cell lung/radiotherapy
Carcinoma, non-small cell lung/chemotherapy
Treatment outcome
