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目的应用同期放化疗治疗肺癌所致上腔静脉综合征,以期提高疗效及安全性。方法对符合入组病例,经一般处理后,予诱导化疗2周期,小细胞肺癌(SCLC)应用EP方案:DDP 20 mg/ m~2,静脉滴注,d1～4;Vp-16 100 mg/m~2,静脉滴注,d 5～7。非小细胞肺癌(NSCLC)应用GP方案:GEM 1000 mg/m~2,静脉滴注,d1、8;DDP 20 mg/m~2,静脉滴注,d2～4。同期放化疗:诱导化疗结束1～2周后无放疗禁忌证,可予以同期放化疗:DDP 20 mg/m~2,静滴,d1～4,3周后重复,共2周期。同时予以肺部病灶加纵隔及双锁上根治性放疗,每次300～400 cGy,每日应用地塞米松5 mg,2～4次后再改为200 cGy/d。照射剂量应视肿瘤的病理类型而定。小细胞肺癌(SCLC)3000～3500 cGy/3～4周,非小细胞肺癌(NSCLC)及未分型5000～6000 cGy/5～6周,其间注意放化疗毒副应及并发症的处理。补充化疗:同期放化结束后,休息3～4周,应进行补充化疗。据不同病理类型采用不同的化疗方案及疗程。小细胞肺癌予以CAO、EP、CE等方案化疗4～6周期,非小细胞肺癌予以NP、GP、TP等方案化疗2～3周期,未分型采用EP方案化疗3～4周期。结果入组53例,51例可评价疗效,临床症状缓解率为89.6%。CR 6例,PR 33例,NC 9例,PD 5例,有效率为73.6%。1年生存率56.3%,2年生存率33.9%,3年生存率9.4%。结论此种治疗模式可作为肺癌合并SVCS的规范治疗模式,亦可对其他恶性肿瘤合并SVCS的治疗有较好的指导作用。
Objective To apply concurrent chemoradiotherapy to treat superior vena cava syndrome caused by lung cancer in order to improve the curative effect and safety. Methods The patients who met the criteria of EP group were treated with DDP 20 mg / m ~ 2, intravenous drip, d1 ~ 4, Vp-16 100 mg / m ~ 2, intravenous drip, d 5 ~ 7. Non-small cell lung cancer (NSCLC) application of GP regimen: GEM 1000 mg / m ~ 2, intravenous drip, d1,8; DDP 20 mg / m ~ 2, intravenous drip, d2 ~ The same period of radiotherapy and chemotherapy: induction chemotherapy after 1 to 2 weeks without radiocontrast contraindications, may be the same period of chemotherapy: DDP 20 mg / m ~ 2, intravenous infusion, d1 ~ 4, 3 weeks after the repeat, a total of 2 cycles. At the same time to lung lesions plus mediastinum and double-locked radical radiotherapy, each 300 ~ 400 cGy, daily dexamethasone 5 mg, 2 to 4 times and then changed to 200 cGy / d. Irradiation dose should be determined depending on the type of tumor pathology. Small cell lung cancer (SCLC) 3000 ~ 3500 cGy / 3-4 weeks, non-small cell lung cancer (NSCLC) and non-subtype 5000-6000 cGy / 5-6 weeks, during which attention should be given to the side effects of radiotherapy and chemotherapy and complications. Supplementary chemotherapy: the same period of radiotherapy after the rest 3 to 4 weeks, should be supplemented chemotherapy. According to different pathological types of different chemotherapy and treatment. Small cell lung cancer is treated with 4 to 6 cycles of chemotherapy such as CAO, EP, and CE. Non-small cell lung cancer is treated with 2 to 3 cycles of chemotherapy such as NP, GP or TP, and 3 to 4 cycles of EP without chemotherapy. Results A total of 53 patients were enrolled in this study. Twenty-one patients were evaluated for efficacy and the rate of clinical symptom relief was 89.6%. CR 6 cases, PR 33 cases, NC 9 cases, PD 5 cases, the effective rate was 73.6%. The 1-year survival rate was 56.3%, the 2-year survival rate was 33.9% and the 3-year survival rate was 9.4%. Conclusion This treatment model can be used as a normative treatment model for SVCS with lung cancer and can also guide the treatment of other malignant tumors combined with SVCS.