【摘要】 目的 :比较三维适形放疗与普通放疗结合同步化疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效及毒副反应。方法 :64例ⅢA/ⅢB期NSCLC随机分成两组 ,三维适形放疗组采用三维适形放疗技术 ,每次 3～ 6Gy ,1次 /d ,照射 10～ 2 0次 ,肿瘤灶总生物有效量为 80～ 90Gy。普通放疗组放疗量在60～ 66Gy。两组同时给予长春瑞滨 2 5mg/m2 ,放疗开始的d1、d8、d2 9、d3 6、d57、d64、d85、d92 静脉滴入 ;卡铂 3 0 0mg/m2 ,放疗开始的d1、d2 9、d57、d85静脉滴入。结果 :三维适形放疗组有效率 96 88% (3 1/ 3 2 ) ,其中CR为17例 ,PR为 14例。普通放疗组有效率为81 2 5 % ,其中CR为 9例 ,PR为 15例。三维适形放疗组的有效率明显高于普通放疗组 ,P =0 0 19。三维适形放疗组和普通放疗组的 1、2年生存率分别为 84 3 8%、40 63 %和 78 13 %、2 3 5 6% ,中位生存时间分别为19个月、16个月 ,其差异有统计学意义 ,P =0 0 189。适形放疗组III度放射性食管炎、放射性肺炎发生率分别为 6 2 5 % (2 / 3 2 )、3 13 % (1/ 3 2 ) ,低于普通放疗组的 46.9%(15 / 3 2 )和 18.8% (6/ 3 2 ) ,两组间差异有统计学意义 ,P =0 0 0 0 ,P =0 0 0 1。结论 :三维适形放疗和同步化疗是ⅢA/ⅢB期非小细胞肺癌安全有效的治疗手段 ,值得进一步临更多还原

【Abstract】 OBJECTIVE:To evaluate the therapeutic effect and toxicity of three dimensional conformal radiotherapy (CRT) and concurrent vinorelbine, and carboplatin chemotherapy in locally advanced, unresectable, Stage Ⅲ non small cell lung cancer (NSCLC).METHODS: Between October 1999 and October 2002, 64 patients were divided randomly into the following groups: CRT group was given to a total dose of 80-90 Gy (3-6 Gy/fraction 10-20 fractions)by using three dimensional conformal radiotherapy techniques, and conventional radiotherapy group was given to a total dose of 60-66 Gy (2 Gy/fraction 30-33 fractions). Both groups were given four cycles of concurrent chemotherapy (vinorelbine 25 mg/m 2 on Days 1,8,29,36,57,64,85 and 92. carboplatin 300 mg/m 2 on Days 1,29,57 and 85).RESULTS:The response rate was 96 88%, composed of 17 complete responders and 14 partial responders for CRT group,and 81 25%,9, 15 for conventional radiotherapy group, respectively, P =0 019. The survival rate was 84 4% at 1 year, 40 6% at 2 years, the median survival time was 19 months for CRT group and compared with 78 13%,23 56%,16 months for conventional radiotherapy group, respectively, P =0 018 9. Grade 3 radiation esophagitis and pneumonitis occurred in 6 25%(2/32),3 13%(1/32)for CRT group patients,and occurred in 46 9%(15/32),18 8% (6/32) for conventional radiotherapy group patients.CONCLUSIONS: Three dimensional CRT and concurrent chemotherapy, as described here, is a well tolerated regimen with acceptable toxicity. More effective treatment schemes are required to improve local disease control and overall survival.更多还原