三维适形放疗同步顺铂对ⅲ期非小细胞肺癌的临床研究

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1、三维适形放疗同步顺铂对Ⅲ期非小细胞肺癌的临床研究作者：牛德森郁志龙郭卫东【摘要】目的：评价三维适形放疗同步顺铂化疗对Ⅲ期非小细胞肺癌的毒性和疗效。方法：70例Ⅲ期非小细胞肺癌病人随机分成两组，40例(三维适形放疗组，3DCRT)接受了剂量为4Gy×15次的三维适形放疗，另30例（综合组，CMT）接受了与上组相同剂量的三维适形放疗，同时给予顺铂5mg/m2每日一次静脉滴注，按WHO疗效及毒性标准来评价治疗毒性和近期疗效，用Kaplan-Meier法计算生存率并绘制生存曲线。结果：所有病人都完成了治疗，三维适形放疗组和综合组中1+2级血液毒性

2、分别为8例和14例，1+2级胃肠道毒性反应4例和20例；1+2级食道反应20例和16例，3级1例；1+2级放射性肺炎分别14例和11例，3级1例和2例。完全缓解（CR）分别6例和3例，部分缓解（PR）26例和23例，无变化（NR）6例和2例，肿瘤进展（PD）2例和1例。局部控制率为34/40（85.0%）和28/30（93.3%），1年生存率为77.5%和83.3%。结论：放射剂量为4Gy×15次的三维适形放疗毒性反应不大，近期疗效肯定；三维适形放疗同步顺铂化疗对Ⅲ期非小细胞肺癌的近期疗效有所改善，毒性反应也有增加，但可以接受。【关键词】

3、放疗；顺铂；非小细胞肺癌9AbstractObjective:Toevaluatetheclinicaltoxicityandeffectofthree-dimensionalconformalradiotherapy(3DCRT)andthree-dimensionalconformalradiotherapywithconcurrentDDPinfusionchemotherapy(CMT)forlocallyadvancedstageIIInon-smallcelllungcancer.Methods:FromJune2003toM

4、ay2005,aseriesof70patientswereallottedtothisclinicstudy,Therewere40patientsinthe3DCRTgroup,(31males,9femalesranginginagefrom40to76).25patientshadclinicalstageIIIAand15patientshadclinicalstageIIIBlesions.30patientswereprovedashavingsquamouscarcinoma,7withadenocarcinomaand3

5、withothertypes.IntheCMTgroup,therewere22males,8females,withamedianageof63years(range38to78).17patientshadclinicalstageIIIAand13patientshadclinicalstageIIIBlesions.22patientswereprovedashavingsquamouscarcinoma,6adenocarcinoma,2forothertypes.TheDDPwithadoseintensityrangeof5

6、mg/m2dilutedwith500mLsalinewasdailyadministratedintheCMTgroup,radiotherapywasdeliveredtotheprimarylesion.ipsilateralhilum,relevantmediastinum,andbilateralsupraclavicularregionsatatotaldoseof60Gyby6mvphotonor6mevelectrons.allpatientsreceivedradiotherapywithadoseof4Ｇy×15.Ka

7、rnofskyscoreswerehigherthan70forallcases.Toxicitiesandeffectswere9evaluatedaccordingtothecriteriaofWHO.ThesurvivalratewascalculatedandsurvivalcurvewasplottedbyKaplan-Meier.Results:ThepatientsintheCMTgroupwithgrade1+2leukocytopeniaandgastrointestinaltoxicityweresignificant

8、lyincreasedcomparedwithpatientsinthe3DRTgroup.Pneumoniaandradiation-inducedesophagitishadnodiffe