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目的观察紫杉醇顺铂周方案同步调强放疗(IMRT)治疗局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法34例局部晚期NSCLC,同步组(14例)采用紫杉醇顺铂周方案化疗联合同步调强放疗;序贯组(20例)采用紫杉醇顺铂周方案序贯化疗联合紫杉醇顺铂周方案化疗。同步组紫杉醇每次剂量50mg/m2,第1、8、15天;顺铂25mg/m2,第1、8、15天,每4周重复。放疗采用调强技术,靶区剂量60Gy,5次/周,200cGy/次。序贯组在放疗前给予2周期紫杉醇顺铂周方案化疗后2周行调强放疗。结果全组34例,完全缓解(CR)3例(8.8%),部分缓解(PR)19例(55.9%),有效率(CR+PR)64.7%,稳定(SD)8例(23.5%),进展(PD)4例(11.8%)。中位生存期为16.5个月,1年和2年,总生存率分别为62.5%和37.5%。同步组患者Ⅱ～Ⅲ级急性放射性食管炎发生率为50%(7/14)、Ⅱ～Ⅲ级急性放射性肺炎发生率为35.7%(5/14)、Ⅱ～Ⅲ级白细胞减小发生率为35.7%(5/14);序贯组分别为45%(9/20)、30%(6/20)、25%(5/20)。同步组有1例出现Ⅳ度白细胞减少,1例出现Ⅳ级急性放射性肺炎。结论紫杉醇顺铂周方案同步调强放疗(IMRT)治疗局部晚期NSCLC有较高的有效率,毒副反应可以耐受。
Objective To observe the curative effect and toxicity of cisplatin-weekly regimen combined with IMRT in the treatment of locally advanced non-small cell lung cancer (NSCLC). Methods Totally 34 patients with locally advanced NSCLC were treated with paclitaxel plus cisplatin weekly chemotherapy combined with intensity modulated radiotherapy. The sequential group (n = 20) was treated with sequential chemotherapy with paclitaxel followed by cisplatin weekly chemotherapy. Syncope group paclitaxel 50mg / m2 each dose, the first 1,8,15 days; cisplatin 25mg / m2, the first 1,8,15 days, repeated every 4 weeks. Radiotherapy using intensity modulation technology, target dose 60Gy, 5 times / week, 200cGy / times. In the sequential group, two cycles of paclitaxel followed by cisplatin weekly chemotherapy and radiotherapy were performed 2 weeks after radiotherapy. Results There were 34 cases of complete remission (CR) in 3 cases (8.8%), partial remission (PR) in 19 cases (55.9%), effective rate (CR + PR) in 64 cases and stable (SD) in 8 cases , Progress (PD) in 4 cases (11.8%). The median survival time was 16.5 months, 1 year and 2 years, and the overall survival rates were 62.5% and 37.5% respectively. The incidence of grade Ⅱ ~ Ⅲ acute radiation esophagitis was 50% (7/14) in patients of synchronous group, 35.7% (5/14) in type Ⅱ ~ Ⅲ acute radiation pneumonitis, and the incidence of Ⅱ ~ Ⅲ grade leukopenia was 35.7% (5/14); sequential group were 45% (9/20), 30% (6/20), 25% (5/20) respectively. One patient in the synchronization group had Grade IV leukopenia and one patient had Grade IV acute radiation pneumonitis. Conclusions Paclitaxel cisplatin weekly synchronous intensity modulated radiation therapy (IMRT) for the treatment of locally advanced NSCLC has a high efficiency, toxicity can be tolerated.