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目的探讨拒绝手术或有手术禁忌证的早期非小细胞肺癌患者接受三维适形放射治疗(3DCRT)合并化疗的可行性。方法共60例经病理组织学和(或)细胞学确诊拒绝手术或有手术禁忌证的早期非小细胞肺癌患者,30例接受三维适形放射治疗配合NP方案化疗(治疗组)2~4个周期,另外30例单纯接受三维适形放射治疗(对照组),分割剂量3~6 Gy/次,5次/周,放疗总量DT63~72 Gy。靶区仅包括肿瘤原发灶和转移淋巴结。结果治疗组和对照组1,2,3年生存率分别为100%、90.5%、81.2%和100%、78.6%、56.5%。治疗组疗效较好,但无统计学差异(P>0.05)。两组骨髓抑制发生率分别为100%和20.0%,差异有显著性(P<0.05)。两组均未出现3级以上的放射性肺炎和放射性食管炎。结论3DCRT治疗对于拒绝手术或有手术禁忌证的早期非小细胞肺癌与手术治疗相比有近似的疗效,副作用可以耐受,配合化疗可以减少因远处转移引起的死亡,提高生存率,但因病例数较少仍需要进一步研究。
Objective To investigate the feasibility of three-dimensional conformal radiotherapy (3DCRT) combined with chemotherapy in patients with early-stage non-small cell lung cancer who are refused surgery or contraindicated in surgery. Methods A total of 60 patients with early-stage non-small cell lung cancer who underwent histopathological and / or cytological diagnosis of contraindications to surgery or contraindications to surgery were enrolled. Thirty patients undergoing three-dimensional conformal radiotherapy with NP regimen (treatment group) The other 30 patients received 3D conformal radiotherapy alone (control group). The dose was 3 ~ 6 Gy / time and 5 times / week. The total amount of radiotherapy was DT63 ~ 72 Gy. The target area only includes the primary tumor and metastatic lymph nodes. Results The 1, 2, 3-year survival rates of the treatment group and the control group were 100%, 90.5%, 81.2% and 100%, 78.6% and 56.5% respectively. The treatment group is better, but no significant difference (P> 0.05). The incidence of bone marrow suppression in both groups was 100% and 20.0%, respectively, with significant difference (P <0.05). No grade 3 or more radiation pneumonitis and radiation esophagitis were found in either group. Conclusions 3DCRT has similar curative effect to surgical treatment for early non-small cell lung cancer who refuse surgery or have contraindications to surgery. The side effects are tolerable. Chemotherapy can reduce the death caused by distant metastasis and improve the survival rate. Less cases still need further study.