适形放疗联合NP化疗与单纯NP化疗治疗晚期非小细胞肺癌临床疗效分析

1、适形放疗联合NP化疗与单纯NP化疗治疗晚期非小细胞肺癌临床疗效分析         10-02-05 10:30:00     作者：龙洪清    编辑：studa20【摘要】  目的 回顾分析适形放疗联合化疗与单纯NP方案化疗治疗晚期非小细胞肺癌的临床疗效和毒副作用。方法 76例期和期非小细胞肺癌患者资料。单纯化疗组31例，接受单纯NP方案化疗。NP方案为诺维本25mg/m2，d1，d8；DDP25mg/m2，d13，21d

2、为1周期。放疗联合化疗组45例，接受适形放疗联合NP方案化疗，NP方案化疗两周期后续行三维适形常规分割放疗，之后再行NP方案化疗。放射源为直线加速器X线，15MV，照射剂量3666Gy。锁骨上区预防照射，8MeV电子线，2030Gy。结果 放疗联合化疗组有效率（RR）57.8%，其中3例达到完全缓解，单纯化疗组有效率（RR）32.3%，两组间P0.05，其差异有统计学意义。放疗联合化疗组中鳞癌RR65.6%，腺癌RR41.7%，P0.05，其差异有统计学意义；A、B和期RR分别为83.3%, 61.1%和33.3%，P0.05，三者间差异有统计学意义，A期与期有效率P0.01，其差异有统计学意

3、义；初治、复治RR为60.1%、20.0%，P0.05，其差异有统计学意义。单纯化疗组中鳞癌与腺癌、B期与期、初治与复治之间有效率差异无统计学意义。放疗联合化疗组的中位疾病进展时间（TTP）为178d（60446d）。单纯化疗组的中位TTP为82d（25233d）。放疗联合化疗组的毒副反应较单纯化疗组多一些，重一些，主要毒副反应为骨髓抑制、胃肠道反应、放射性肺炎和放射性食管炎，均可以通过相应措施予以纠正、缓解。结论 适形放疗联合NP方案化疗较单纯NP方案化疗对晚期非小细胞肺癌有较好的近期疗效，TTP也较长些，毒副反应能够予以纠正、缓解。 【关键词】  适形放疗 化疗 非小细胞肺癌&#

4、160;   ABSTRACT：Objective  To analyze retrospectively the clinical effects and side effects of conformal radiotherapy combined with NP chemotherapy and NP chemotherapy for advanced nonsmall cell lung cancer. Methods  76 patients with and stage nonsmall cell lung cancer were group

5、ed. Chemotherapy group consisted of 31 patients, treated with NP chemotherapy. The NP regimen includes Navelbine (25mg/m2, d1, d8) and DDP (25mg/m2, d13), repeated every 21 days. Radio chemotherapy group consisted of 45 patients, receiving threedimensional conformal radiotherapy(3DCRT) combined with

6、 NP chemotherapy. Conventional fraction 3dimentional conformal radiotherapy was performed, using 15MV xrays from linear accelerator, after 2 cycles of NP chemotherapy, with total dose 36 to 66 Gy. Then, two more cycles of NP chemotherapy were performed. Prophylactic supraclavicular irradiation was d

7、elivered, using 8MeV Electron Beam with total dose of 20 to 30Gy. Results The overall response rate(RR) was 57.8% in the radiochemotherapy group, with 3 patients achieved complete responses, 32.3% in the chemotherapy group, there was a significent difference(P0.05) between RR of the two groups. In t

8、he radiochemotherapy group, RR was 65.6% in patients with squamous cell carcinoma, 41.7% in patients with adenocarcinoma,there was a statistical difference(P0.05) between RR of the two types. RR of the stage A, B and was 83.3%, 61.1% and 33.3% respectively, there were statistical differences(P0.05)

9、among RR of the three stages. RR was 60.1% in the patients with initially diagnosed, 20.0% with recurrence, P0.05. In the chemotherapy group, there was no statistics difference(P0.05) between RR of patients with squamous cell carcinoma and with adenocarcinoma, patients of stage B and , patients in i

10、nitially diagnosed and in recurrence. Medium time to progression (TTP) was 178 days (60446d) in the radiochemotherapy group, while medium TTP was 82 days(25233days) in the chemotherapy group. Toxicity side effects in the radiochemotherapy group were more than those in the chemotherapy group. Major t

11、oxicity side effects included bone marrow suppression, gastrointestinal side effects，radiation pneumonitis and radiation esophagitis, all of which could be relieved by corresponding measurements. Conclusion The response rate of comformal radiotherapy combined with NP chemotherapy is higher than NP c

12、hemotherapy alone for advanced nonsmall cell lung cancer, with tolerable toxicity side effects,and longer TTP.    KEY WORDS：Conformal radiotherapy；Chemotherapy；Nonsmall cell lung cancer    非小细胞肺癌(NSCLC)在肺癌病例中约占70%80%，半数以上的患者在确诊时已达中晚期，失去了手术时机。放射治疗是不能手术切除患者的主要治疗手段之一，化疗是晚期

13、患者，特别是期患者主要治疗手段之一。但是对于晚期患者(、期)，采用单纯化疗或单纯放疗的近期疗效和远期疗效均不理想。放疗联合化疗的综合治疗对于晚期非小细胞肺癌患者尤为重要。适形放疗联合NP方案化疗能否较好提高NSCLC患者近期、远期疗效，能否具有较好的安全性，是我们关注的焦点。我们整理了2004年2月到2007年7月间放化疗科适形放疗联合NP方案化疗和单纯NP方案化疗的病例资料，现报告如下。    1  资料与方法    1.1  临床资料    自2004年2月到2007年7月间收治住

14、院的病人资料。患者经病理学（纤支镜活检或锁骨上淋巴结活检）或细胞学（经皮肺穿或支气管刷片）证实为非小细胞肺癌，经医学影像学技术（CT或MRI或PET或SPECT或B超）全面检查后确定为A或B或期的病例（UICC1997年分期标准），均有可测量或可评价的病灶。患者无明显心、肝、肾、肺功能异常，Karnofsky评分大于70分。从前未进行过抗肿瘤治疗或停用抗肿瘤治疗达6月以上患者为初治患者。复治患者为停用其它抗肿瘤治疗达5周以上6月以下者。治疗前均由患者本人或家属签署化疗知情书或放疗知情同意书。放疗组联合化疗组45例中男36例，女9例，50岁以下8例，5160岁18例，60岁以上19例。病理类型：

15、鳞癌32例，腺癌12例，大细胞癌1例；临床分期：A期11例，B期19例，期15例；初治41例，复治4例。单纯化疗组31例中男24例，女7例，50岁以下9例，5160岁15例，60岁以上7例。病理类型：鳞癌14例，腺癌16例，腺鳞癌1例；临床分期：A期2例，B期10例，期19例；初治26例，复治5例。    1.2  治疗方法    单纯化疗组采用NP方案，诺维本25mg/m2 d1，d8；DDP25mg/m2，d13，21d为1周期。化疗前水化，化疗期间护胃、护肝、预防呕吐，化疗后监测血常规指标和肝肾功能变化，必要时使用粒细胞集落刺激因子（GCSF）支持。    放疗联合化疗组采用化疗与适形放疗序贯方式