阿米福汀在局部晚期非小细胞肺癌放疗中的作用研究

摘要

目的 探讨阿米福汀在局部晚期非小细胞肺癌(NSCLC)放疗中对近期疗效的影响及降低放射性食管炎和放射性肺炎的作用.方法 2008年1月-2010年2月我院放疗科收治62例局部晚期NSCLC患者,采用随机数字表法分为单纯三维适形放疗组(对照组)和阿米福汀+三维适形放疗组(试验组).试验组每次放疗前15～30 min给予阿米福汀300 mg/m2,静脉滴注.每周放疗5次,持续6周.放疗结束后6周评价两组患者的近期疗效.放疗期间每周记录1次放射性食管炎、放射性肺炎的发生率.结果 两组共44例患者完成了预定试验,对照组23例,试验组21例.对照组完全缓解(CR)1例,部分缓解(PR)11例,客观有效率为52%;试验组CR 2例,PR 12例,客观有效率为67%,两组客观有效率比较差异无统计学意义(χ2=0.95,P＞0.05).对照组累计发生放射性食管炎15例(65%),放射性肺炎16例(70%);试验组累计发生放射性食管炎和放射性肺炎各5例(24%),两组放射性食管炎和放射性肺炎累计发生率比较,差异均有统计学意义(P值分别为0.017和0.003).结论 阿米福汀可以降低 NSCLC放疗中放射性食管炎和放射性肺炎的发生率,但不降低放疗的近期疗效.%Objective To evaluate the short - term effect of locally advanced NSCLC patients treated with radiotherapy and to understand its effect on alleviating radiation esophagitis and radiation pneumonitis. Methods 62 patients with locally advanced NSCLC admitted to radiotherapy department of our hospital from January 2008 to February 2010 were randomly divided into pure 3D conformal radiotherapy group ( control group ) and amifostine combined with 3D conformal radiotherapy group ( experiment group ). The experiment group was given 15 to 30 min intravenous drip of 300 mg/m amifostine. Six weeks after radiotherapy , the short - term effect of the two groups was assessed. During radiotherapy, the incidences of radiation esophagitis and radiation pneumonitis were recorded every week. Results A total of 44 patients completed the experiment with 23 in control group and 21 in experiment group. In the control group, 1 case had complete remission and 11 cases had partial remission with an objective response rate of 52% . While in the experiment group, 2 cases had complete remission and 12 cases had partial remission with an objective response rate of 67%. The objective response rate between the two groups showed no statistically significant difference ( x2=0. 95, P >0. 05 ). 15 cases ( 65% ) had radiation esophagitis and 16 cases had radiation pneumonitis ( 70% ) in the control group, while 5 cases ( 24% ) had radiation esophagitis and 5 cases ( 24% ) had radiation pneumonitis. The incidences of radiation esophagitis and radiation pneumonitis between the two groups showed statistically significant difference ( P = 0. 017 and 0. 003 respectively ). Conclusion Amifostine can significant decrease the risk of developing serious radiation esophagitis and radiation pneumonitis without reducing response rate in NSCLC patients treated by radiotherapy.