• 1 南充市中心醫(yī)院腫瘤防治中心（四川南充，637000）;2 川北醫(yī)學(xué)院附屬醫(yī)院放射科介入室;

【摘要】　目的　 探討后程適形放射治療（3 dimensional comformal radiation therapy，3D-CRT）同步化學(xué)療法治療Ⅲ期非小細(xì)胞肺癌（non-small-cell lung cancer，NSCLC）的近期療效。　方法　 搜集2005年1月-2008年6月NSCLC患者共115例，其中53例行單純后程3D-CRT（單放組），62例行后程3D-CRT聯(lián)合同步化學(xué)療法（聯(lián)合組），所有患者均經(jīng)病理證實(shí)為Ⅲ期NSCLC。兩組放射治療方案均采用常規(guī)分割治療加后程3D-CRT，DT 62～72 Gy。聯(lián)合組化學(xué)療法采用TP（紫杉醇 + 順鉑）方案。　結(jié)果　 單放組和聯(lián)合組近期療效（完全緩解+部分緩解）分別為75.47%、91.94%，差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05）。單放組和聯(lián)合組的治療不良反應(yīng)主要有白細(xì)胞、血小板減少，放射性食管炎，放射性氣管炎，惡心、嘔吐等胃腸道反應(yīng)。骨髓抑制和消化道反應(yīng)，聯(lián)合組稍高于單放組。經(jīng)對癥治療后，所有患者均可耐受。　結(jié)論　 后程3D-CRT聯(lián)合TP方案化學(xué)療法較單純后程適形放射治療明顯提高Ⅲ期NSCLC近期療效。患者耐受性尚可。
【Abstract】　Objective　 To observe the recent therapeutic effect of late course 3 dimensional conformal therapy concomitant with chemotherapy on locally advanced stage Ⅲ non-small-cell lung cancer (NSCLC).　Methods　 From January 2005 to June 2008, 115 patients with stage Ⅲ NSCLC were confirmed by pathology, in whom 53 only underwent late course conformal therapy (radiotherapy group), and another 62 underwent late course conformal therapy concomitant with chemotherapy (combined group). The radiotherapy schema of the two groups was routine division plus late course conformal therapy (with DT 62-72 Gy). The chemotherapy schema in the combined group was performed with TP (paclitaxel and DDP).　Results　 The recent curative effect (complete remission plus partial remission) in radiotherapy group and combined group was 75.47% and 91.94%, respectively (P lt;0.05). The frequent adverse reactions in the two groups included leucocytopenia, thrombocytopenia, radioactive esophagitis, radioactive tracheitis, nauseated, and emesia. The rate of bone marrow depression and alimentary canal reaction in combined group was higher than that in the radiotherapy group. In the two groups, all patients could tolerance the treatments.　Conclusion　 Late course 3 dimensional conformal therapy concomitant with TP schema chemotherapy for NSCLC could raise the recent curative effect. The patients could tolerance the treatments.

引用本文： 趙彩霞,任勇軍,文世民,李光明,潘榮強(qiáng). 后程適形放射治療聯(lián)合化學(xué)療法治療Ⅲ期非小細(xì)胞肺癌近期療效觀察. 華西醫(yī)學(xué), 2011, 26(2): 216-218. doi: 復(fù)制

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2. 　Newlin HE, Iyengar M, Morris CG, et al. Unresectable squamous cell carcinoma of the lung: an outcomes study[J]. Int J Radiat Oncol Biol Phys, 2009, 74(2): 370-376.
3. 　El Sharouni SY, Aerts JG, Senan S, et al. Treatment of patients with stage Ⅲ non-small cell lung cancer: concurrent high-dose chemotherapy and radiotherapy[J]. Ned Tijdschr Geneeskd, 2008, 152(50): 2714-2717.
4. 　林貴山, 程惠華, 傅志超, 等. 晚期非小細(xì)胞肺癌同步放化療的療效分析[J]. 中華放射腫瘤學(xué)雜志, 2006, 15(6): 462-466.
5. 　Socinski MA, Morris DE, Halle JS, et al. Induction and concurrent chemotherapy with high-dose thoracic conformal radiation therapy in unresectable stage IIIA and IIIB non-small-cell lung cancer: a dose-escalation phase I trial[J]. J Clin Oncol, 2004, 22(21): 4341-4350.
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7. 　李慧, 杜小波, 廖東彪, 等. 三維適形放療與NP方案同步治療Ⅲ期非小細(xì)胞肺癌的近期療效觀察[J]. 華西醫(yī)學(xué), 2007, 22(2): 264-265.
8. 　Liang SX, Zhu XD, Xu ZY, et al. Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance[J]. Int J Radiat Oncol Biol Phys, 2006, 65(2): 426-434.
9. 　Rosenman JG, Halle JS, Socinski MA, et al. High-dose conformal radiotherapy for treatment of stage ⅢA/ⅢB non-small-cell lung cancer: technical issues and results of a phase Ⅰ/Ⅱ trial[J]. Int J Radiat Oncol Biol Phys, 2002, 54(2): 348-356.
10. 　朱禮, 吳榮. Ⅲ期非小細(xì)胞肺癌同期放化療與序貫放化療的對照研究[J]. 中華腫瘤防治雜志, 2009, 16(14): 1105-1107.
11. 　Schwachöfer JH, Crooijmans RP, Hoogenhout J, et al. Effectiveness in inhibition of recovery of cell survival by cisplatin and carboplatin: influence of treatment sequence[J]. Int J Radiat Oncol Biol Phys, 1991, 20(6): 1235-1241.
12. 　Fietkan R. Concomitant radiochemotherapy of advanced non-small-cell lung cancer[J]. Lung Cancer, 2001, 33(Suppl 1): 65-76.
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  2. 2. 　Newlin HE, Iyengar M, Morris CG, et al. Unresectable squamous cell carcinoma of the lung: an outcomes study[J]. Int J Radiat Oncol Biol Phys, 2009, 74(2): 370-376.
  3. 3. 　El Sharouni SY, Aerts JG, Senan S, et al. Treatment of patients with stage Ⅲ non-small cell lung cancer: concurrent high-dose chemotherapy and radiotherapy[J]. Ned Tijdschr Geneeskd, 2008, 152(50): 2714-2717.
  4. 4. 　林貴山, 程惠華, 傅志超, 等. 晚期非小細(xì)胞肺癌同步放化療的療效分析[J]. 中華放射腫瘤學(xué)雜志, 2006, 15(6): 462-466.
  5. 5. 　Socinski MA, Morris DE, Halle JS, et al. Induction and concurrent chemotherapy with high-dose thoracic conformal radiation therapy in unresectable stage IIIA and IIIB non-small-cell lung cancer: a dose-escalation phase I trial[J]. J Clin Oncol, 2004, 22(21): 4341-4350.
  6. 6. 　Bradley JD, Bae K, Graham MV, et al. Primary analysis of the phase Ⅱ component of a phase Ⅰ/Ⅱ dose intensification study using three-dimensional conformal radiation therapy and concurrent chemotherapy for patients with inoperable non-small-cell lung cancer: RTOG 0117[J]. J Clin Oncol, 2010, 28(14): 2475-2480.
  7. 7. 　李慧, 杜小波, 廖東彪, 等. 三維適形放療與NP方案同步治療Ⅲ期非小細(xì)胞肺癌的近期療效觀察[J]. 華西醫(yī)學(xué), 2007, 22(2): 264-265.
  8. 8. 　Liang SX, Zhu XD, Xu ZY, et al. Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance[J]. Int J Radiat Oncol Biol Phys, 2006, 65(2): 426-434.
  9. 9. 　Rosenman JG, Halle JS, Socinski MA, et al. High-dose conformal radiotherapy for treatment of stage ⅢA/ⅢB non-small-cell lung cancer: technical issues and results of a phase Ⅰ/Ⅱ trial[J]. Int J Radiat Oncol Biol Phys, 2002, 54(2): 348-356.
  10. 10. 　朱禮, 吳榮. Ⅲ期非小細(xì)胞肺癌同期放化療與序貫放化療的對照研究[J]. 中華腫瘤防治雜志, 2009, 16(14): 1105-1107.
  11. 11. 　Schwachöfer JH, Crooijmans RP, Hoogenhout J, et al. Effectiveness in inhibition of recovery of cell survival by cisplatin and carboplatin: influence of treatment sequence[J]. Int J Radiat Oncol Biol Phys, 1991, 20(6): 1235-1241.
  12. 12. 　Fietkan R. Concomitant radiochemotherapy of advanced non-small-cell lung cancer[J]. Lung Cancer, 2001, 33(Suppl 1): 65-76.