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目的观察诱导化疗加后程加速超分割放疗(LCHART)不能手术的局部晚期非小细胞肺癌(NSCLC)的毒性和疗效。方法58例不能手术的ⅢA(N2)～ⅢB期NSCLC患者随机进入研究。以顺铂为基础的联合方案诱导化疗2～4个周期后进行LCHART。放疗第一阶段前后对穿大野包括原发灶、转移淋巴结和区域淋巴引流区照射,2.0Gy/次,1次/d,总剂量40Gy;第二阶段缩野照射临床肿瘤灶,1.5Gy/次,2次/d,总剂量27Gy。结果53例适合进行统计分析。放疗结束后1个月增强CT评价有效率为58.5%。1、2、3、4年生存率分别为59.3%、22.8%、13.7%、11.4%,1、2、3、4年局部肿瘤无进展生存率分别为43.6%、22.9%、12.9%、8.6%。粒细胞下降3级12例,4级3例;放射性食管炎2级14例,3级2例;放射性肺炎2级9例,3级1例。晚期放射性肺损伤2级6例,3级1例。化疗无效者中59.5%发生了远地转移,化疗有效者中仅18.8%(P=0.006)。结论诱导化疗2～4个周期加LCHART治疗局部晚期NSCLC的毒性可以耐受,中位生存期较其他诱导化疗加常规放疗有所提高,胸腔内肿瘤进展是主要死因。
Objective To observe the toxicity and curative effect of locally advanced non-small cell lung cancer (NSCLC) inducible chemotherapy plus late accelerated hyperfractionation radiotherapy (LCHART). Methods 58 cases of unresectable stage Ⅲ A (N2) ~ Ⅲ B NSCLC patients were randomized into the study. Cisplatin-based combination regimen induces chemotherapy after 2 to 4 cycles of LCHART. Before and after the first stage of radiotherapy, a total dose of 40Gy was administered to Wearing Ono, including primary tumor, metastatic lymph nodes and regional lymphatic drainage area at a dose of 2.0Gy / time with a total dose of 40Gy; , 2 times / d, the total dose of 27Gy. Results 53 cases were suitable for statistical analysis. One month after the end of radiotherapy, the effective rate of enhanced CT evaluation was 58.5%. The 1, 2, 3, 4-year survival rates were 59.3%, 22.8%, 13.7%, 11.4% respectively. The progression-free survival rates of local tumors at 1, 2, 3, 4 years were 43.6%, 22.9%, 12.9% %. There were 12 cases with grade 3 neutropenia and 3 cases with grade 4. There were 14 cases with esophagitis grade 2 and 2 cases with grade 3, 9 cases with radiation pneumonia grade 2 and 1 case with grade 3. Grade 2 advanced radiotherapy lung injury in 6 cases, 3 cases in 1 case. 59.5% of chemotherapy-ineffective distant metastases, chemotherapy, only 18.8% (P = 0.006). Conclusions Induction chemotherapy with 2-4 cycles plus LCHART can tolerate the toxicity of locally advanced NSCLC. The median survival time is higher than that of other induction chemotherapy and conventional radiotherapy. Thoracic tumor progression is the major cause of death.