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直线加速器联合γ刀放疗同步DP方案化疗治疗局部晚期非小细胞肺癌的临床研究

Clinical Effects of Accelerator Linear Plus Gamma Knife Radiotherapy Combined with Concurrent DP Regimen Chemotherapy for Locally Advanced Non-small Cell Lung Cancer

  • 摘要: 目的观察直线加速器联合γ刀放疗同步DP方案化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和不良反应。方法96例局部晚期NSCLC患者随机分为A、B、C三组。A组患者同时接受DP方案化疗及肺内原发灶和阳性淋巴结放疗,6MV X线,50Gy/25F,之后给予γ刀加量20Gy/4F;化疗共4周期。B组患者同时接受DP方案化疗及肺内原发灶和阳性淋巴结放疗,6MV X线,60~66 Gy/30~33F;化疗共4周期。C组患者先接受DP方案化疗2周期后,再给予6MV X线放疗肺内原发灶和阳性淋巴结60~66Gy/30~33F,之后再行DP方案化疗2周期。结果90例患者按计划完成了治疗。A、B、C三组总有效率分别为87.1%、86.7%和62.1%,A、B两组总有效率相当,均高于C组(PAB=1.000,PAC=0.025,PBC=0.030)。三组患者1年总生存率分别为77.4%、73.3%和72.4%,三组相比差异均无统计学意义(PAB=0.711,PAC=0.655,PBC=0.937)。治疗的不良反应主要为急性放射性食管炎、放射性肺炎、骨髓抑制和消化道反应。2级及以上放射性肺炎的发生率分别为32.3%,60.0% 和20.7%,B组高于A组和C组,A、C两组相当(PAB= 0.030,PAC=0.311, PBC=0.002);2级及以上骨髓抑制的发生率分别为61.3%,66.7%和31.0%,A、B两组相当,均高于C组(PAB=0.662 ,PAC=0.019,PBC=0.006);放射性食管炎和消化道反应三组相比差异无统计学意义。结论直线加速器联合γ刀同步DP方案化疗治疗局部晚期NSCLC的近期疗效好,不良反应经对症处理后患者能耐受,但其远期疗效和并发症有待进一步观察。

     

    Abstract: ObjectiveTo investigate the short-term effects and adverse reactions of accelerator linear and gamma knife radiotherapy combined with concurrent DP chemotherapy for locally advanced non-small cell lung cancer(NSCLC). MethodsNinety six patients with locally advanced NSCLC were randomly assigned to three treatment arms. In group A, patients received accelerator linear and gamma knife radiotherapy combined with concurrent 4 cycles of DP chemotherapy. The treatment plans were accelerator linear using 6MV x-rays by 50Gy/25F,and then gamma knife radiotherapy by 20Gy/4F, once every other day. In group B, patients received accelerator linear radiotherapy by (60~66)Gy/(30~33)F with concurrent 4 cycles of DP chemotherapy. In group C, patients received accelerator linear radiotherapy using 6MV x-rays by (60~66)Gy/(30~33)F after 2 cycles of DP chemotherapy, and then received another 2 cycles of DP chemotherapy. ResultsNinety patients finished the treatment. The overall response rates of the three groups were 87.1%, 86.7% and 62.1%, respectively (PAB=1.000, PAC=0.025, PBC=0.030). The overall 1-year survival rates of the three groups were 77.4%, 73.3% and 72.4%, respectively(PAB=0.711, PAC=0.655, PBC=0.937). The adverse reactions were radiation pneumonitis, radiation esophagitis, gastrointestinal effects and myelosuppression. The incidence rates of radiation pneumonitis more than gradel were 32.3%, 60.0% and 20.7%, respectively (PAB=0.030, PAC=0.311, PBC=0.002). The incidence rates of myelosuppression over gradel were 61.3%,66.7% and 31.0%,respectively(PAB=0.662,PAC=0.019,PBC=0.006). ConclusionThe combination of accelerator linear plus gamma knife radiotherapy with concurrent DP chemotherapy can improve the short-term effects in locally advanced NSCLC patients with acceptable toxicities although the long-term effects and toxicities need to be further researched.

     

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