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目的结合临床实践经验,开展适形放疗在III期非小细胞肺癌的临床研究。方法选择2007年1月~2009年12月收治的经病理证实的IIIa或者IIIb期非小细胞肺癌患者73例为研究对象,采用总结回顾分析法,将研究对象的临床资料进行搜集整理,并与经治医师、责任护士共同探讨病例,探讨适形放疗在III期非小细胞肺癌的临床应用价值。结果近期疗效:原发灶总体有效率为93.15%,纵隔转移淋巴结总体有效率为100.00%,腺癌总体有效率为96.77%,鳞癌总体有效率为80.56%。截至2010年12月,73例患者获得完全随访,随访率达到为100%。全组患者1、2年局控率分别为63.01%和41.11%,全组平均生存时间为(18.91±1.12)个月,1、2年生存率分别为75.34%(55/73)和46.57%(34/73)。其中,Ⅲa期平均时间为(25.33±2.12)个月,1、2年生存率为84.63%、64.12%;Ⅲb期中位生存时间(13.39±2.12)个月,1、2年生存率为66.77%、27.37%。主要毒性表现为白细胞下降,总发生率为94.52%(69/73),其中Ⅲ、Ⅳ度白细胞下降为35.62%(26/73),其次为恶心、呕吐,总发生率为32.88%(24/73),多为Ⅰ、Ⅱ级;急性放射反应主要表现为I、II级放射性食管炎、肺炎,其发生率分别为53.42%(39/73)和12.33%(9/73),未见有Ⅲ、Ⅳ级放射性食管炎、肺炎发生。结论三维适形放射治疗联合低密度化疗对III期非小细胞肺癌进行治疗,取得了较好的疗效,且毒副反应可以耐受,值得临床推广应用。
Objective To combine clinical experience with conformal radiotherapy in stage III non-small cell lung cancer. Methods Seventy-three patients with pathologically confirmed non-small cell lung cancer (IIIa or IIIb) who were admitted from January 2007 to December 2009 were selected as the research objects. The clinical data of the study subjects were collected and analyzed with the help of retrospective analysis. The treatment of physicians, nurses to discuss the case of patients to discuss the clinical application of conformal radiotherapy in stage III non-small cell lung cancer. Results The recent curative effect: The overall effective rate of primary tumor was 93.15%, the overall effective rate of mediastinal lymph node metastasis was 100.00%, the overall effective rate of adenocarcinoma was 96.77%, and the overall effective rate of squamous cell carcinoma was 80.56%. As of December 2010, 73 patients were completely followed up and the follow-up rate was 100%. The overall control rate at 1 year and 2 years was 63.01% and 41.11% respectively, and the mean survival time was (18.91 ± 1.12) months in all the patients. The survival rates at 1 and 2 years were 75.34% (55/73) and 46.57% (34/73). The mean survival time in stage Ⅲa was (25.33 ± 2.12) months and the one-year and two-year survival rates were 84.63% and 64.12% respectively. The median survival time in stage Ⅲb was 13.39 ± 2.12 months and the one-year and two-year survival rates were 66.77% , 27.37%. The main toxicity was leukopenia, with a total incidence of 94.52% (69/73). The grade Ⅲ and Ⅳ leukopenia was 35.62% (26/73), followed by nausea and vomiting, with a total incidence of 32.88% (24 / 73), mostly grade Ⅰ, Ⅱ; acute radiation reaction mainly as Class I, II radio esophagitis, pneumonia, the incidence was 53.42% (39/73) and 12.33% (9/73), no see Ⅲ, Ⅳ radio esophagitis, pneumonia occurred. Conclusion Three-dimensional conformal radiotherapy combined with low-density chemotherapy for the treatment of stage III non-small cell lung cancer, and achieved good results, and toxicity can be tolerated, worthy of clinical application.