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目的研究大分割三维适形放疗联合低剂量密集式化疗治疗临床III期非小细胞肺癌的疗效及毒副反应。方法72例Ⅲ期NSCLC患者均采用大分割三维适形放射治疗,单次治疗剂量为400cGy,治疗次数为14次,总剂量为56Gy,18~21d完成;同期采用低剂量密集式TP方案化疗,化疗疗程为4~6周期。结果72例患者获得完全随访。肺原发灶总有效率为93.1%;纵隔转移淋巴结总有效率为100.0%。肺鳞癌总有效率为93.5%;肺腺癌总有效率为81.1%。全组患者1、2年局控率分别为63.9%和41.7%;中位生存时间为18.9个月,1、2年生存率分别为76.2%和47.2%。白细胞下降总发生率为95.8%;恶心、呕吐反应为33.3%;I、II级急性放射性食管炎和放射性肺炎发生率分别为54.2%和12.5%。结论大分割三维适形放疗联合低剂量密集式化疗治疗III期非小细胞肺癌有较好的近期疗效,毒副作用可耐受,远期疗效待观察。
Objective To study the curative effect and toxicity of large-segment three-dimensional conformal radiotherapy combined with low-dose intensive chemotherapy in the treatment of clinical stage III non-small cell lung cancer. Methods Seventy-two patients with stage Ⅲ NSCLC were treated with large-scale three-dimensional conformal radiotherapy. The single treatment dose was 400cGy, the number of treatments was 14 times and the total dose was 56Gy. The course of 18-21 days was completed. In the same period, Chemotherapy for 4 to 6 cycles. Results 72 patients were completely followed up. The total effective rate of primary lung cancer was 93.1%; the total effective rate of mediastinal lymph node metastasis was 100.0%. The total effective rate of lung squamous cell carcinoma was 93.5%; the total effective rate of lung adenocarcinoma was 81.1%. The overall control rates at 1 and 2 years were 63.9% and 41.7% respectively. The median survival time was 18.9 months. The 1-year and 2-year survival rates were 76.2% and 47.2% respectively. The total incidence of leukopenia was 95.8%; nausea and vomiting was 33.3%; the incidence of acute radioactive esophagitis and radiation pneumonitis of grade I and II were 54.2% and 12.5% respectively. Conclusion Large-segment three-dimensional conformal radiotherapy combined with low-dose intensive chemotherapy for the treatment of stage III non-small cell lung cancer has a good short-term efficacy, side effects can be tolerated, long-term efficacy to be observed.