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目的探讨同步放化疗后程立体定向体部放疗(SBRT)补量模式治疗局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法入组确诊不能手术的ⅢA或ⅢB期NSCLC患者32例,采用多西紫杉醇联合顺铂化疗3～4个周期(多西紫杉醇75mg/m2第1天,顺铂20mg/m2第1～4天;每3～4周为1个周期),化疗开始1周内进行放疗。采用三维适形放射治疗(3DCRT)对原发病灶及受累淋巴结区常规分割照射50～60Gy,结束4～6周复查CT,在不超过周围重要正常组织器官耐受剂量条件下对残留病灶补充SBRT剂量18～27Gy。评价近期疗效及毒副反应。结果 32例患者均能按计划完成治疗。同步放化疗的有效率(RR)为68.8%(22/32),残留病灶SBRT补量后RR提高至81.2%(26/32),但差异无统计学意义(P>0.05)。全组患者的中位肿瘤进展时间和总生存时间分别为12.6个月和21.8个月;1年无进展生存率和1年、2年生存率分别59.4%和81.3%、46.9%。主要毒副反应包括骨髓抑制、恶心呕吐、1～2级急性放射性肺炎及食管炎,经积极处理后均可耐受。结论同步放化疗后程SBRT补量模式治疗局部晚期NSCLC的疗效及安全性良好。
Objective To investigate the efficacy and toxicity of simultaneous stereotactic body radiotherapy (SBRT) supplementation for the treatment of locally advanced non-small cell lung cancer (NSCLC). Methods Thirty-two patients with stage IIIA or IIIB NSCLC who were diagnosed as inoperable were enrolled in this study. Chemotherapy with docetaxel combined with cisplatin was performed for 3 to 4 cycles (at the first day of docetaxel 75 mg/m2 and at the first 4 days of cisplatin 20 mg/m2). Every 3 to 4 weeks is 1 cycle), and radiotherapy is performed within 1 week after the start of chemotherapy. Three-dimensional conformal radiation therapy (3DCRT) was used to perform routine segmentation of primary lesions and involved lymph nodes with 50 to 60 Gy, and CT scans were completed 4 to 6 weeks later. SBRT was supplemented to residual lesions under conditions that did not exceed the tolerance of surrounding normal normal tissue organs. Dose 18 ~ 27Gy. Evaluate the short-term efficacy and side effects. Results All 32 patients were able to complete the treatment as planned. The effective rate (RR) of concurrent chemoradiotherapy was 68.8% (22/32), and RR of residual lesions after SBRT was increased to 81.2% (26/32), but the difference was not statistically significant (P>0.05). The median tumor progression time and overall survival time for the whole group were 12.6 months and 21.8 months, respectively; 1-year progression-free survival rate and 1-year and 2-year survival rates were 59.4%, 81.3%, and 46.9%, respectively. The main toxicities and side effects include myelosuppression, nausea and vomiting, grade 1 to 2 acute radiation pneumonitis, and esophagitis, which can be tolerated after active treatment. Conclusion The efficacy and safety of postoperative concurrent SBRT plus mode in the treatment of locally advanced NSCLC is good.