Objective To evaluate the efficacy and toxicity of docetaxel combined cisplatin concurrent chemoradiotherapy with later stereotactic body radiotherapy( SBRT) in treatment of locally advanced non-small cell lung cancer( LANSCLC). Methods A total of 32 eligible patients diagnosed with inoperable LANSCLC( IE A. or SIB) were assigned to treat with docetaxei combined cispSa-tin chemotherapy at least 3 or 4 cycles( docetaxel 75 mg/m2 on day 1 ,and cisplatin 20 mg/m2 on day 1-4,repeated every 3-4 weeks). The concurrent thoracic radiotherapy was given within one week after the first chemotherapy cycle in all patients. The primary tumors and involved lymph nodes were administrated three-dimensional confonnul radiotherapy ( 3 DCRT) with a total dose af 50 to 60Gy (200cGy/fraction,5f/week .completed in 5 to 6 weeks) in all patients. After 4-6 weeks of 3DCRT,all patients received computerized tomographic scanning and those with residual tumor lesions were administrated additional stereotactic body radiotherapy ( SBRT) with (he doses of l8-27Gy(300cGy/fraction,every other day) and without exceeding the tolerated doses of surrounding important normal organ. The efficacy was evaluated according to REC1ST criteria. The toxicities were evaluated according to NCI CTC 3. 0 criteria and RTOG/EORT radiation reaction criteria. Results All the patients finished the planed concurrent chemoradiotherapy and later SBRT. Though the response rate( RR) raised to 81. 2% (26/32) after SBRT, the differences were not significant compared with 68. 8% ( 22/ 32 ) after 3 DCRT (P> 0.05). Till the lasl follew-up day,time to progression (TTP) and median survival time(MST) were 12.6 month and 21. 8 month, respectively. 1-year progression free survival rate and 1-year and 2-year overall survival rate were 59. 4% ,81. 3% , 46. 9% , respectively. The main toxicities were myelosuppression,nausea and vomiting,acute radiation pneumonitis and acute radiation esophagetis. All the toxicities could be relieved and tolerated after appropriate treatment. Conclusion Concurrent chemoradiotherapy with later SBRT can be considered as an effective and feasible approach in treatment of ehoosed LANSCLC.%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 人组确诊不能手术的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.
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