【摘要】 目的评价适形调强放疗联合表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗晚期非小细胞肺癌(NSCL-C)的疗效和不良反应。方法 42例初治或复发的ⅢB~Ⅳ期NSCLC患者,采用三维适形或调强放疗,范围包括原发灶及转移灶。肺原发灶剂量40~60 Gy/20~30次,脑转移灶先行全脑放疗30Gy/10次(或40 Gy/20次),再缩野加量9Gy/3次(或20Gy/10次);骨转移灶放疗30 Gy/10次或40 Gy/20次。自放疗第1天起开始服EGFR-TKI(埃克替尼125 mg,2次/d;或吉非替尼250 mg,1次/d;或厄洛替尼150mg,1次/d),直至疾病进展或出现不可耐受的不良反应。放射治疗结束1个月后评价疗效及不良反应。结果 42例患者有效率和疾病控制率分别为28.6%(12/42)、64.3%(27/42);中位疾病进展时间(MTTP)8.1个月,中位生存期(MST)15.5个月。1年和2年生存率分别为58.6%和12.3%。毒副反应以Ⅰ~Ⅱ级为主,Ⅲ级不良反应有皮肤的痤疮样皮疹及皮肤搔痒,粒细胞减少、腹泻、食欲减退、贫血,无Ⅲ级放射性肺炎及食管炎发生。结论采用适形或调强放疗联合EGFR-TKI治疗晚期非小细胞肺癌治疗有较好的近期疗效及生存,不良反应轻微,多数患者能耐受治疗。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of three-dimensional conformal radiotherapy(3D-CRT)or intensity-modulated radiotherapy(IMRT)combined with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)for patients with advanced non-small cell lung cancer(NSCLC).Methods Forty two patients with initial or relapse ⅢB-Ⅳ stage NSCLC received 3D-CRT or IMRT on primary and metastatic lesions.Radiation dose for thoracic primary lesions was 40-60Gy/20~30 fractions;and whole brain radiotherapy(WBRT)was administered at a dose 30Gy/10 fractions(or 40 Gy/20 fractions)for brain metastasis,then boost to 9Gy/3 fractions(or 20Gy/10 fractions);the dose for bone metastasis was 30 Gy(10 fractions)or 40Gy(20 fractions).From d1 of treatment,patients took EGFR-TKIs(Icotinib 125 mg,bid;or gefitinib 250 mg,qd;or erlotinib150 mg,qd)till tumor progression or unacceptable toxicities.After one month the efficacy and adverse reaction of the treatment were evaluated.Results In 42 cases,the response rate was 28.6%(12/42)and the disease control rate was 64.3%(27/42).Median time to tumor progression(MTTP)was 8.1m;median survival time(MST)was 15.5m.The 1-y and 2-y survival rates were 59.6%and12.3%respectively.The main toxicities were Ⅰ-Ⅱ level,and the Ⅲ level reactions included acne-like rashes and pruritis,granulocytopenia,diarrhea,loss of appetite,anemia;however radiation pneumonitis or esophagitis were not observed.Conclusion CRT or IMRT combined with EGFR-TKIs is safe and effective for patients with advanced or metastatic NSCLC.更多还原