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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、晚期非小细胞肺癌采用分组治疗。A组采用常规放疗加化疗,共30例,放疗量60～66Gy,B组采用三维适形放疗加化疗,共30例,放疗量64～70Gy;C组采用三维适形调强放疗加化疗,共12例,放疗量70～76Gy。3组均采用铂类联合诺维苯方案化疗1周期后放疗,放疗结束后再化疗3～5周期。结果:A组有效率(CR+PR)43.3%,B有效率70%,C有效率83.3%,A组与B组,A组与C组比较,差异有统计学意义(P<0.05);1年生存率:A组1年生存率40%(8/20),B组为66.67%(12/18),C组为100%(4/4)。B、C组合并后的1年生存率与A组比较,差异有统计学意义(P=0.03);3组的骨髓抑制等基本相同;放射性食管炎:A组56.7%,B组43.3%,C组25%,3组间差异无统计学意义(P=0.16)。急性放射性肺炎:A组56.7%8,B组33.3%;C组16.7%。A组与C组比较,差异有统计学意义(P=0.031)。结论:在中、晚期非小细胞肺癌的治疗中,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、毒副作用轻、病人容易耐受等特点;适形调强放疗在不增加放疗副作用的同时,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 cases of advanced non-small cell lung cancer were treated by grouping. A group of conventional radiotherapy plus chemotherapy, a total of 30 cases, radiotherapy 60 ~ 66Gy, B group using three-dimensional conformal radiotherapy plus chemotherapy, a total of 30 cases, radiotherapy volume 64 ~ 70Gy; C group using three-dimensional conformal IMRT plus chemotherapy, A total of 12 cases, radiotherapy volume 70 ~ 76Gy. 3 groups were treated with platinum combined with Novatec chemotherapy after 1 cycle of radiotherapy, chemotherapy after the end of 3 to 5 cycles of chemotherapy. Results: The effective rate (CR + PR) of group A was 43.3%, the effective rate of B was 70% and the effective rate of 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% (8/20) in group A, 66.67% (12/18) in group B and 100% (4/4) in group C, respectively. The 1-year survival rates of group B and C were significantly different from those of group A (P = 0.03). The three groups had the same bone marrow suppression and other similarities. Radiation esophagitis was 56.7% in group A, 43.3% in group B, C group 25%, no significant difference between the three groups (P = 0.16). Acute radiation pneumonitis: A group 56.7% 8, B group 33.3%; C group 16.7%. The difference between group A and group C was statistically significant (P = 0.031). Conclusion: In the treatment of advanced non-small cell lung cancer, three-dimensional conformal or IMRT combined with chemotherapy with conventional radiotherapy combined with chemotherapy, with good efficacy, mild side effects, the patient easily tolerated characteristics; Strong radiotherapy without increasing the side effects of radiotherapy at the same time, can improve the 1-year survival rate and target dose irradiation.