适形放疗联合NP化疗与单纯NP化疗治疗晚期非小细.docVIP

　　适形放疗联合NP化疗与单纯NP化疗治疗晚期非小细 【摘要】 目的 回顾分析适形放疗联合化疗与单纯NP方案化疗治疗晚期非小细胞肺癌的临床疗效和毒副作用。方法 76例Ⅲ期和Ⅳ期非小细胞肺癌患者资料。单纯化疗组31例，接受单纯NP方案化疗。NP方案为诺维本25mg/m2，d1，d8；DDP25mg/m2，d13，21d为1周期。放疗联合化疗组45例，接受适形放疗联合NP方案化疗，NP方案化疗两周期后续行三维适形常规分割放疗，之后再行NP方案化疗。放射源为直线加速器X线，15MV，照射剂量36～66Gy。锁骨上区预防照射，8MeV电子线，20～30Gy。结果 放疗联合化疗组有效率（RR）57.8%，其中3例达到完全缓解，单纯化疗组有效率（RR）32.3%，两组间P＜0.05，其差异有统计学意义。放疗联合化疗组中鳞癌RR65.6%，腺癌RR41.7%，P＜0.05，其差异有统计学意义；ⅢA、ⅢB和Ⅳ期RR分别为83.3%, 61.1%和33.3%，P＜0.05，三者间差异有统计学意义，ⅢA期与Ⅳ期有效率P＜0.01，其差异有统计学意义；初治、复治RR为60.1%、20.0%，P＜0.05，其差异有统计学意义。单纯化疗组中鳞癌与腺癌、ⅢB期与Ⅳ期、初治与复治之间有效率差异无统计学意义。放疗联合化疗组的中位疾病进展时间（TTP）为178d（60～446d）。单纯化疗组的中位TTP为82d（25～233d）。放疗联合化疗组的毒副反应较单纯化疗组多一些，重一些，主要毒副反应为骨髓抑制、胃肠道反应、放射性肺炎和放射性食管炎，均可以通过相应措施予以纠正、缓解。结论 适形放疗联合NP方案化疗较单纯NP方案化疗对晚期非小细胞肺癌有较好的近期疗效，TTP也较长些，毒副反应能够予以纠正、缓解。 【关键词】 适形放疗 化疗 非小细胞肺癌 ABSTRACT：Objective To analyze retrospectively the clinical effects and side effects of conformal radiotherapy bined otherapy and NP chemotherapy for advanced nonsmall cell lung cancer. Methods 76 patients all cell lung cancer otherapy group consisted of 31 patients, treated otherapy. The NP regimen includes Navelbine (25mg/m2, d1, d8) and DDP (25mg/m2, d13), repeated every 21 days. Radio chemotherapy group consisted of 45 patients, receiving threedimensional conformal radiotherapy(3DCRT) bined otherapy. Conventional fraction 3dimentional conformal radiotherapy ed, using 15MV xrays from linear accelerator, after 2 cycles of NP chemotherapy, ore cycles of NP chemotherapy ed. Prophylactic supraclavicular irradiation otherapy group, otherapy group, there otherapy group, RR ous cell carcinoma, 41.7% in patients a,there ong RR of the three stages. RR otherapy group, there ous cell carcinoma and a, patients of stage ⅢB and Ⅳ, patients in initially diagnosed and in recurrence. Medium time to progression (TTP) otherapy group, edium TTP otherapy group. Toxicity side effects in the radiochemotherapy group ore than those in the chemotherapy group. Major toxicity side effects included bone marroonitis and radiatio