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目的:分析调强放疗(IMRT)联合化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应。方法:48例局部晚期不能手术或不愿手术的NSCLC患者,采用IMRT同步联合化疗综合治疗。放疗采用5～7野IMRT技术,单次剂量2.0～2.2Gy,每周5次,中位总剂量60Gy(54～66Gy)。所有患者均接受2个周期长春瑞滨加顺铂方案同步化疗,放疗结束后辅助2～4个周期化疗。结果:所有患者均顺利完成同步放化疗计划。放疗结束3个月后评价疗效,CR为21%(10/48),PR为60%(29/48),SD为13%(6/48),PD为6%(3/48),有效率为81%(39/48)。中位随访时间为11个月(7～30个月),中位生存时间为25个月,1和2年总生存率分别为73%和39%。按RTOG标准评价放疗毒副反应,放射性食管炎Ⅰ级15例,Ⅱ级11例,Ⅲ级1例;放射性气管炎Ⅰ级14例,Ⅱ级8例,Ⅲ级3例;放射性肺炎Ⅰ级6例,Ⅱ级4例,Ⅲ级1例。结论:IMRT联合化疗对局部晚期NSCLC患者有较好的疗效,毒副反应可以被绝大多数患者耐受,对生存率的提高有待进一步研究。
Objective: To analyze the short-term curative effect and toxicity of IMRT combined with chemotherapy in the treatment of locally advanced non-small cell lung cancer (NSCLC). Methods: Forty-eight patients with locally advanced NSCLC who were unable or unwilling to undergo surgery were treated with IMRT combined with chemotherapy. Radiotherapy using 5 ~ 7 field IMRT technology, a single dose of 2.0 ~ 2.2Gy, 5 times a week, the median total dose of 60Gy (54 ~ 66Gy). All patients received 2 cycles of vinorelbine and cisplatin regimen synchronous chemotherapy, adjuvant chemotherapy after 2 to 4 cycles of radiotherapy. Results: All patients completed the concurrent chemoradiation plan successfully. The efficacy was evaluated 3 months after the end of radiotherapy, CR was 21% (10/48), PR was 60% (29/48), SD was 13% (6/48), PD was 6% (3/48) Efficiency is 81% (39/48). The median follow-up time was 11 months (range 7-30 months) with a median survival time of 25 months, with a 1-year and 2-year overall survival of 73% and 39%, respectively. According to the RTOG standard, the radioactive side effects of radiotherapy were 15 cases of grade Ⅰ, 11 cases of grade Ⅱ and 1 case of grade Ⅲ; 14 cases of grade Ⅰ, 8 cases of grade Ⅱ and 3 cases of grade Ⅲ; Cases, Ⅱ grade in 4 cases, Ⅲ grade in 1 case. Conclusion: IMRT combined with chemotherapy has a good effect on patients with locally advanced NSCLC. Toxicity and side effects can be tolerated by most patients. The improvement of survival rate needs further study.