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目的:评价三维适形调强放疗联合化疗在治疗中、晚期非小细胞肺癌(NSCLC)的作用。方法:72例中、晚期NSCLC患者采用分组治疗。A组采用常规放疗加化疗,共30例;B组采用三维适形放疗加化疗,共30例;C组采用三维适形调强放疗加化疗,共12例。三组均采用铂类联合盖诺方案化疗1个周期后放疗,放疗结束后再化疗3~5个周期。结果:A组有效率(CR+PR)43·3%,B组有效率70%·0,C组有效率83·3%,A组与B组,A组与C组差异有统计学意义,P<0·05;1年生存率:A组40·0%(8/20),B组为66·7%(12/18),C组为100·0%(4/4)。B、C组合并后的1年生存率与A组差异有统计学意义,P=0·03;三组的骨髓抑制等基本相同;放射性食管炎,三组间差异无统计学意义,P=0·16。急性放射性肺炎:A组56·7%,B组33·3%;C组16·7%。A组与C组差异有统计学意义,P=0·031。结论:在中、晚期NSCLC的治疗中,三维适形或调强放疗联合化疗与与常规放疗联合化疗相比,具有疗效好、毒副反应轻、患者容易耐受等特点;适形调强放疗在不增加放疗不良反应的同时,能够提高1年生存率和靶区的照射剂量。
Objective: To evaluate the effect of three-dimensional conformal intensity modulated radiation therapy combined with chemotherapy on the treatment of advanced non-small cell lung cancer (NSCLC). Methods: 72 patients with advanced NSCLC were treated with subgroups. A group of conventional radiotherapy plus chemotherapy, a total of 30 cases; B group using three-dimensional conformal radiotherapy and chemotherapy, a total of 30 cases; C group using three-dimensional CRT and radiotherapy plus chemotherapy, a total of 12 cases. Three groups were treated with platinum combined with Gentamycin chemotherapy after 1 cycle of radiotherapy, chemotherapy after the end of 3 to 5 cycles of chemotherapy. Results: The effective rate (CR + PR) in group A was 43.3%, the effective rate in group B was 70% · 0, the effective rate in group C was 83.3%. There was significant difference between group A and group B, group A and group C , P <0.05. The 1-year survival rate was 40.0% (8/20) in group A, 66.7% (12/18) in group B and 100.0% (4/4) in group C, respectively. The 1-year survival rates of group B and group C were significantly different from those of group A (P = 0.03). The bone marrow suppression and other three groups were basically the same. Radiation esophagitis had no significant difference among the three groups (P = 0 · 16. Acute radiation pneumonitis was 56.7% in group A, 33.3% in group B, and 16.7% in group C. The difference between group A and group C was statistically significant, P = 0 · 031. Conclusion: In the treatment of advanced NSCLC, three-dimensional conformal or IMRT combined with chemotherapy with conventional radiotherapy combined with chemotherapy, with good efficacy, mild side effects, patients with easy tolerance and other characteristics; conformal IMRT Without increasing the side effects of radiotherapy, the one-year survival rate and target dose can be increased.