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目的比较全身伽玛刀与普通放疗结合同步化疗治疗局部晚期非小细胞肺癌(NSCLC)的效果及毒副反应。方法将64例ⅢA/ⅢB期NSCLC患者随机分成两组,全身伽玛刀组采用三维适形放疗技术,每次3~6 Gy,1次/天,照射10~20次,肿瘤灶总生物有效量为80~90 Gy。普通放疗组放疗量在60~66 Gy。在放疗同时联合化疗,顺铂80~100mg/m2,静脉滴注;氟脲嘧啶2.5g/m2或氟脲苷2.5g/m2,静脉滴注,21~28天为1个周期,连续2~4个周期。结果全身伽玛刀组有效率为96.88%,普通放疗组有效率为75.00%,全身伽玛刀组和普通放疗组的1、2年生存率分别为84.38%、40.63%和78.13%、25.00%。全身伽玛刀组Ⅲ度放射性食管炎、放射性肺炎发生率分别为6.25%(2/32)、3.13%(1/32),低于普通放疗组的43.75%(14/32)和21.88%(7/32)。结论全身伽玛刀和同步化疗是ⅢA/ⅢB期非小细胞肺癌安全有效的治疗手段,值得进一步临床研究。
Objective To compare the efficacy and side effects of systemic gamma knife radiotherapy with conventional radiotherapy in the treatment of locally advanced non-small cell lung cancer (NSCLC). Methods Sixty-four patients with stage ⅢA / ⅢB NSCLC were randomly divided into two groups. The whole body gamma knife group was treated with three-dimensional conformal radiotherapy (3 ~ 6 Gy, 1 time / day) for 10 ~ 20 times. The amount of 80 ~ 90 Gy. Radiotherapy in the general radiotherapy group 60 ~ 66 Gy. Radiotherapy combined with chemotherapy, cisplatin 80 ~ 100mg / m2, intravenous infusion; fluorouracil 2.5g / m2 or floxuridine 2.5g / m2, intravenous infusion, 21 to 28 days for a cycle of 2 ~ 4 cycles. Results The total effective rate of the whole body gamma knife group was 96.88% and that of the general radiotherapy group was 75.00%. The 1-year and 2-year survival rates of the whole body gamma knife group and the conventional radiotherapy group were 84.38%, 40.63% and 78.13%, 25.00% . The incidences of grade Ⅲ radiation esophagitis and radiation pneumonitis were 6.25% (2/32) and 3.13% (1/32) in the Gamma knife group, respectively, which were lower than 43.75% (14/32) and 21.88% (14/32) in the radiotherapy group 7/32). Conclusions Whole body gamma knife and synchronous chemotherapy are safe and effective treatments for stage ⅢA / ⅢB non-small cell lung cancer and deserve further clinical study.