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局部晚期非小细胞肺癌后程加速超分割联合同期化疗的临床观察
作者:吴桂平  赵婷婷  张霞  刘小宇 
单位:贵航贵阳医院肿瘤科  贵州 贵阳 550025 
关键词: 非小细胞肺/放射疗法  非小细胞肺/药物疗法 肺肿瘤/放射疗法 肺肿瘤/药物疗法 存活率 放射剂量分次 治疗结果 综合疗法 临床对照试验 
DOI:10.13267/j.cnki.syzlzz.2018.06.013
出版年,卷(期):页码:2018,33(6):560-564
摘要:

目的 探讨后程加速超分割放疗(late course accelerated hyperfractionation radiotherapy,LCAHR)联合同期化疗在局部晚期非小细胞肺癌(locally advanced non-small-cell lung cancer,LANSCLC)中的近期疗效和不良反应。方法 选取LANSCLC患者65例,依照数字表法随机分为对照组(n=32,常规分割2.0 Gy/f,1次/d,5次/周,总剂量66~70 Gy,总治疗时间33~35 d)和研究组(n=33,2个治疗阶段:第1阶段常规分割2.2 Gy/f,1次/d,5次/周,总剂量57~59 Gy;后进入第2阶段:加速超分割,2.0 Gy/f,2次/d,8~10次/周,总剂量16~20 Gy;2个阶段累积总剂量73~79 Gy,总治疗时间31~32 d)。两组放疗期间均联合同期化疗,对两组近期疗效、生存时间、不良反应和死亡原因进行比较分析。结果 治疗结束随访3~36个月,研究组的治疗总有效率为84.8%,高于对照组的75.0%,差异具有统计学意义(P<0.05)。研究组的1、2、3年生存率分别为54.5%、30.3%和18.2%,高于对照组的40.6%、18.8%和9.4%,差异均具有统计学意义(均P<0.05)。两组患者的主要不良反应为白细胞、血小板减少以及胃肠道反应、放射性食管炎、放射性肺炎。不良反应发生率两组比较,差异无统计学意义(P>0.05)。研究组死亡患者19例,远处转移率24.2%;对照组死亡25例,远处转移率34.4%,两组比较差异具有统计学意义(P<0.05)。结论 LCAHR联合同期化疗治疗LANSCLC近期疗效较好,可提高肿瘤局部控制率,延长患者生存时间,与常规放疗比较并未增加放疗不良反应发生率。

Objective To explore the clinical efficacy and toxicity of the late course accelerated hyperfractionation radiotherapy(LCAHR) combined concurrent chemotherapy in locally advanced non-small-cell lung cancer (LANSCLC). Methods Sixty-five patients with LANSCLC were assigned into control group (n=32,conventional radiotherapy:2.0 Gy/f,once a day,5 f/w,DT:66-70 Gy,33-35 d) and study group (n=33,two stages:conventional radiotherapy for stage Ⅰ:2.2 Gy/f,once a day,5 f/w,DT:57-59 Gy;late course accelerated radiotherapy for stage Ⅱ:2.0 Gy/f,twice a day,8-10 f/w,DT:16-20 Gy;altogether,DT:73~79 Gy,31~32 d).Efficacy,survival time,toxicity and cause of death were compared between the two groups. Results Followed up for 3 to 36 months,the total effective rate of the study group was 84.8%,significantly higher than 75.0% of the control group,and the difference was statistically significant (P<0.05).The 1,2,3-year survival rates of the study group were significantly higher than those of the control group (54.5%,30.3% and 18.2% vs 40.6%,18.8% and 9.4%,all P<0.05).The main side effects of the two groups were leukocyte reduction,gastrointestinal reaction,esophagitis and radiation pneumonitis.The incidence of side effects in the two groups was not significantly different (P>0.05).In the study group,19 patients died,the distant metastasis rate was 24.2%;25 cases in the control group died,the distant metastasis rate was 34.4%.The difference between the two groups was statistically significant (P<0.05). Conclusion LCHART combined concurrent chemotherapy in the treatment of LANSCLC has better short-term efficacy,can significantly increase the local control rate of tumor;increase the survival time of patients,reduce tumor local recurrence and metastasis,and has less side effects.

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