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目的观察后程三维适形放疗(late course conformal radiotherapy,LCCR)配合同步化疗治疗Ⅲ期非小细胞肺癌(NSCLC)的近期疗效与急性毒副反应。方法48例经组织或细胞病理学证实的Ⅲ期非小细胞肺癌患者随机分为两组,每组24例。A组为治疗组,采用后程三维适形推量放疗加同步NP方案化疗:NVB(国产去甲长春花碱)30 mg/m~2,d1、8;DDP 25 mg/m~2,d1～3,21～28 d为一疗程,共4疗程。第一疗程开始即同步放疗,先普通放疗常规分割剂量前后对穿野照射达D_T 40 Gy,后给予三维适形放疗推量达27～30 Gy,3 Gy/次,隔日1次,共9～10次,治疗总量达67～70 Gy;B组为对照组,采用与治疗组相同的化疗方案及疗程,放疗在常规分割前后对穿野照射D_T 40 Gy后于X线模拟定位机下改斜野,避开脊髓,加量D_T 24～28 Gy,总D_T达60～68 Gy。结果48例全部完成治疗计划。治疗组总有效率为83.3%,对照组为54.2%,两组间差异有显著性(P<0.05)。治疗组1年生存率53.4%,对照组42.8%(P>0.05)。治疗组白细胞下降发生率为75.0%,对照组为79.2%;治疗组Ⅲ、Ⅳ度白细胞下降率为45.8%,对照组为54.2%,两组间差异无显著性(P>0.05)。治疗组放射性食管炎和放射性肺炎发生率分别为29.2%和8.3%,均为Ⅰ、Ⅱ级;对照组Ⅰ、Ⅱ级放射性食管炎和放射性肺炎发生率分别为58.3%和33.3%,Ⅲ级放射性食管炎和放射性肺炎分别为8.3%和12.5%,两组比较差异有显著性(P<0.05)。结论后程三维适形放疗配合化疗治疗Ⅲ期非小细胞肺癌有较好的近期疗效,且毒副反应小,故能为多数患者耐受。
Objective To observe the short-term curative effect and acute toxicity of late course conformal radiotherapy (LCCR) combined with concurrent chemotherapy for stage Ⅲ non-small cell lung cancer (NSCLC). Methods Forty-eight patients with stage Ⅲ non-small cell lung cancer confirmed by histopathology or cytopathology were randomly divided into two groups (24 in each group). Group A was the treatment group, which was treated with three-dimensional posterior three-dimensional conformal radiotherapy and concurrent NP regimen chemotherapy: NVB (domestic norvocularine 30 mg / m 2, d 1,8, DDP 25 mg / m 2, 3,21 ~ 28 d for a course of treatment, a total of 4 courses. The first course of treatment is synchronous radiotherapy. The radiotherapy dose of D_T 40 Gy before and after the conventional radiotherapy is 27 ~ 30 Gy, 3 Gy / time, and every other day 9 ~ 10 Times, the total amount of 67 ~ 70 Gy; B group as the control group, with the treatment group and the same chemotherapy regimen, radiotherapy in the conventional segmentation before and after irradiation on the field irradiation D_T 40 Gy after X-ray simulator Field, avoid the spinal cord, add D_T 24 ~ 28 Gy, total D_T of 60 ~ 68 Gy. Results 48 cases completed the treatment plan. The total effective rate was 83.3% in the treatment group and 54.2% in the control group, with significant difference between the two groups (P <0.05). The 1-year survival rate was 53.4% in the treatment group and 42.8% in the control group (P> 0.05). The incidence of leukopenia in the treatment group was 75.0% and that in the control group was 79.2%. The rates of leukopenia in group Ⅲ and Ⅳ were 45.8% in treatment group and 54.2% in control group. There was no significant difference between the two groups (P> 0.05). The incidences of radiation esophagitis and radiation pneumonitis in the treatment group were 29.2% and 8.3% respectively, all of which were grade Ⅰ and Ⅱ. The incidences of radiation esophagitis and radiation pneumonitis in the control group were 58.3% and 33.3% respectively, and grade Ⅲ radioactivity Esophagitis and radiation pneumonitis were 8.3% and 12.5%, respectively, with significant difference between the two groups (P <0.05). Conclusions Three-dimensional conformal radiotherapy combined with chemotherapy in the treatment of stage Ⅲ non-small cell lung cancer has a good short-term curative effect, and the side effects are small, so it can be tolerated in most patients.