论文部分内容阅读
目的探讨及评价化疗联合立体定位放疗,在晚期复治恶性肿瘤治疗中的作用意义。方法 196例患者依据接受主要治疗方法,分为同步化放疗组75例,序贯化放疗组49例,单纯系统化疗72例。放疗均采用体部立体定位放疗装置(伽玛刀)进行,总剂量35~50 Gy。化疗依据不同肿瘤按现行常规方案及剂量进行静脉或胸腹腔内化疗。同步组为伽马刀放疗周期期间同时予以化疗,序贯组为按计划在放疗周期前后进行化疗。结果在各类复治晚期肿瘤患者中同步组、序贯组及单纯化疗组总有效率(ORR)分别为20.0%、14.3%及26.9%(P>0.05)。各组中鼻咽癌及淋巴癌有效率较高于其他肿瘤;肺癌以系统化疗组较高(31.8%),而胰腺癌则以同步放化疗者较高(20%),与其他二组比较差异有显著性。各类肿瘤总平均生存期及中位生存期以单纯系统化疗组最高,分别为14.5个月及10.2个月(与同步化疗组比t=5.06,P<0.05),并且序贯放化疗组高于同步治疗组。不同肿瘤在三组治疗中生存期仍表现为消化系肿瘤最长,肺癌其次,胰腺癌较短。手术后患者经不同治疗生存期长于非手术者。较严重(Ⅲ~Ⅳ度)白细胞减少发生率以单纯系统化疗最高,为12.5%。结论同步化放疗可提高部分肿瘤(如胰腺癌)的有效率并且不增高毒副反应,但总平均生存期及中位生存期以系统单纯化疗较高。故复治晚期肿瘤规范系统化疗是较为合理有效的方法。
Objective To investigate and evaluate the role of chemotherapy combined with stereotactic radiotherapy in the treatment of advanced refractory malignancies. Methods According to the main treatment methods, 196 patients were divided into synchronized radiotherapy group (75 cases), sequential chemoradiotherapy group (49 cases) and systemic chemotherapy alone (72 cases). Radiotherapy using body stereotactic radiotherapy apparatus (gamma knife), the total dose of 35 ~ 50 Gy. Chemotherapy according to different tumors according to the current routine programs and doses of intravenous or intra-thoracic and abdominal chemotherapy. Synchronization group for the gamma knife radiotherapy during the same period to be chemotherapy, sequential group scheduled for radiotherapy cycles before and after chemotherapy. Results The total effective rate (ORR) of the patients in the advanced stage of retreatment was 20.0%, 14.3% and 26.9% respectively (P> 0.05). Nasopharyngeal and lymphoma in each group was more effective than other tumors; lung cancer was higher in the systemic chemotherapy group (31.8%), while pancreatic cancer was higher (20%) with concurrent chemoradiation compared with the other two groups The difference was significant. The overall mean survival time and median survival time of all kinds of tumors were the highest in the systemic chemotherapy group (14.5 months vs. 10.2 months, respectively; t = 5.06 vs the concurrent chemotherapy group, P <0.05) In the synchronized treatment group. Different tumors in the survival of the three groups still showed the longest digestive system tumors, followed by lung cancer, pancreatic cancer is shorter. Patients after surgery by different treatment longer than non-operative survival. The more severe (Ⅲ ~ Ⅳ degree) leukopenia incidence of the highest systemic chemotherapy, the highest was 12.5%. Conclusions Simultaneous radiotherapy can improve the efficiency of some tumors (such as pancreatic cancer) and does not increase the toxicity, but the overall average survival and median survival in the systemic chemotherapy alone is higher. Therefore, the late treatment of tumor regimen systemic chemotherapy is a more reasonable and effective method.