论文部分内容阅读
目的:探讨紫杉醇单药每周化疗联合三维适形放射(3D-CRT)疗法治疗老年局部晚期非小细胞肺癌(NSCLC)的临床安全性。方法:采用多中心、开放模式进行研究。2006年1月至2008年12月共56例Ⅲ期NSCLC患者纳入研究,其中男39例,女17例,年龄60～78岁,中位年龄67岁。56例患者中鳞癌36例,腺癌20例;Ⅲa期NSCLC34例,Ⅲb期NSCLC22例。给予紫杉醇40mg/m2静脉滴注,1次/周;给药后3h采用3D-CRT(6MV-X射线,95%PTV/60Gy/2Gy/30次),1次/d,疗程均为连续6周。4周为1周期,治疗期间及治疗结束后第2周记录原发病灶和纵隔淋巴结转移病灶的变化、不良反应和生存情况。结果:56例患者均完成6周治疗。NSCIC原发病灶总有效率为82.1%(46/56),纵隔淋巴结转移病灶总有效率为91.1%(51/56)。鳞癌、腺癌原发病灶总有效率分别为88.9%(32/36)和70.0%(14/20),纵膈淋巴结转移病灶总有效率分别为97.2%(35/36)和80.0%(16/20),不同病理类型之间疗效差异无统计学意义。化疗急性不良反应以骨髓抑制为主,白细胞减少、血红蛋白减少和血小板减少发生率分别为42.9%(24/56)、51.8%(29/56)和30.4%(17/56),恶心、呕吐发生率为42.9%(24/56);放疗急性不良反应主要为放射性肺炎和放射性食管炎,发生率为17.9%(10/56)和58.9%(33/56),上述不良反应多为轻度反应。鳞癌和腺癌患者疾病进展中位时间为7.8和5.6个月,中位生存期为11.3和10.2个月,1年生存率为47.2%和35.0%,2年生存率为25.0%和15.0%。结论:紫杉醇单药每周化疗联合3D-CRT对老年晚期局部NSCIC近期疗效及安全性均较好。
Objective: To investigate the clinical safety of weekly paclitaxel chemotherapy combined with three-dimensional conformal radiotherapy (3D-CRT) in the treatment of elderly locally advanced non-small cell lung cancer (NSCLC). Methods: Multi-center, open model for research. From January 2006 to December 2008 a total of 56 cases of stage Ⅲ NSCLC patients were enrolled in the study, including 39 males and 17 females, aged 60 to 78 years, with a median age of 67 years. 56 cases of squamous cell carcinoma in 36 cases, adenocarcinoma in 20 cases; Ⅲ a stage NSCLC34 cases, Ⅲ b stage NSCLC22 cases. Administered paclitaxel 40mg / m2 intravenously, once a week; 3D-CRT (6MV-X ray, 95% PTV / 60Gy / 2Gy / 30 times) week. 4 weeks for 1 cycle, during treatment and 2 weeks after the treatment of primary lesions and mediastinal lymph node metastasis lesions, adverse reactions and survival. Results: All 56 patients completed 6 weeks of treatment. The total effective rate of primary NSCIC was 82.1% (46/56), and the total effective rate of mediastinal lymph node metastasis was 91.1% (51/56). The total effective rates of squamous cell carcinoma and adenocarcinoma were 88.9% (32/36) and 70.0% (14/20), respectively. The total effective rates of mediastinal lymph node metastasis were 97.2% (35/36) and 80.0% 16/20). There was no significant difference in curative effect between different pathological types. The main adverse reactions of chemotherapy were bone marrow suppression. The incidences of leukopenia, hemoglobin decrease and thrombocytopenia were 42.9% (24/56), 51.8% (29/56) and 30.4% (17/56), respectively, with nausea and vomiting (42.9%, 24/56). The main adverse reactions of radiotherapy were radiation pneumonitis and esophagitis, the incidence rate was 17.9% (10/56) and 58.9% (33/56), respectively. Most of these adverse reactions were mild reactions . Patients with squamous cell carcinoma and adenocarcinoma had a median progression time of 7.8 and 5.6 months, median survival of 11.3 and 10.2 months, 1-year survival rates of 47.2% and 35.0%, 2-year survival rates of 25.0% and 15.0% . Conclusion: Weekly chemotherapy combined with 3D-CRT of paclitaxel alone is effective and safe in the treatment of advanced local advanced NSCIC.