常规放疗、三维适形放疗联合化疗治疗局部晚期肺癌的疗效比较

摘要

目的 评价三维适形放疗联合化疗(3D-CRT)治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和急性毒副反应.方法 收集2002年4月至2005年12月晚期非小细胞肺癌患者100例,分为三维适形放疗+化疗(A组)50例,常规放疗+化疗(B组) 50例.A、B组化疗方案相同,泰素135 mg/㎡,顺铂70 mg/㎡,第1、29、57天.A组三维适形放疗放射源为6MV-X线,2Gy/(次·d),40Gy后缩野加量,总剂量DT66～70Gy.B组常规放疗.结果 晚期非小细胞肺癌患者经3个月治疗后,Ⅰ、Ⅱ、Ⅲ期CT改变≥50%(11.1%、26.9%、76.9%)与CT改变消失(88.9%、73.3、7.7%),两者比较有显著性差异(χ2=6.70,χ2=6.69,χ2=70.1,P＜0.01);鳞癌3年生存率(60.8%)明显高于腺癌(50.0%)两者比较有显著性差异(χ2=4.10,P＜0.05);A组有效率 (78.0)%明显高于B组(66.0)%(χ2 =4.23,P＜0.05);A组2年生存率(48.0)%高于高于B组(34.0) %(χ2 =4.29,P＜0.05);鳞癌有效率(60.0%)高于腺癌(48.4%)(χ2 =4.12,P＜0.05);放射性肺炎、食道炎、白细胞减少发生率分别为19例(19.0%)、7例(9.0%)、10例(10.0%).结论 3D-CRT联合化疗能提高局部晚期非小细胞肺癌的近期疗效,且急性毒副反应无明显增加.%Objective To evaluate the Short-term effect and acute toxicity by 3D-CRT combined with chemotherapy in patients with NSCLC.Methods From April 2002 to December 2005, 100 patients with advanced non-small cell lung cancer divided into three-dimensional conformal radiotherapy chemotherapy(A group)50 cases and ordinary radiotherapy chemotherapy(B group)50 cases.A,B group the same as chemotherapy with Taxal and 3D-CRT simultaneously. Chemotherapy consisted of dose of 66-70Gy with a 2Gy dose fraction perday,5 days per week. Results The outcome of advanced non-small cell lung cancer patients by 3 months after treatment,Ⅰ,ⅡⅢ period CT change≥50% (11.1%,26.9%,76.9%) and CT changes in the disappearance (88.9%, 73.3,7.7%)were significant difference (χ2= 6.70,χ2= 6.69, χ2=70.1,P＜0.01);squamous cell carcinoma 3-year survival rate (60.8 %) than adenocarcinoma (50.0%) were significant difference (χ2=4.10, P＜0.05);A group efficiency (78.0)% significantly higher than that of B group (66.0)% (χ2= 4.23,P＜0.05);A group of 2-year survival rate(48.0%)higher than Group B(34.0%) (χ2=4.29,P＜0.05);efficient squamous cell carcinoma(60.0%) higher than adeno- carcinoma(48.4%)(χ2=4.12,P＜0.05);The incidence of radioactive pneumonia、 esophagitis、interleukin reduce were 19 cases (19.0%)、7 cases (9.0%)、6.25%、10 cases(10.0%).Conclusions The Short-term effect and acute toxicity can improve by 3D-CRT combined with chemotherapy in patients with NSCLC.