南昌大学学报（医学版）
南昌大學學報（醫學版）
남창대학학보（의학판）
Acta Academiae Medicinae Jiangxi
2015年
4期
29-32
,共4页
非小细胞肺癌,晚期%三维适形放疗%高剂量%吉非替尼
非小細胞肺癌,晚期%三維適形放療%高劑量%吉非替尼
비소세포폐암,만기%삼유괄형방료%고제량%길비체니
non-small-cell lung cancer,advanced%three-dimensional conformal radiotherapy%high dose%gefitinib
目的：观察吉非替尼联合三维适形放疗治疗晚期非小细胞肺癌（NSCLC）的近期疗效及毒副反应，并探索放疗时的最高耐受剂量。方法按放疗总剂量的不同，将32例晚期 NSCLC 分为54、56、58、60 Gy 组（各组的放疗总剂量分别为54、56、58、60 Gy），每组8例。照射区域为原发灶和纵膈累及淋巴结，同时每日口服吉非替尼250 mg 直到放疗结束后第60天，放疗前及放疗结束后1个月进行胸部 CT 检查。疗效和毒副反应分别采用 RECIST 标准、CTCAE 3．0进行评价。结果高剂量放疗组较低剂量组近期疗效更好，即吉非替尼联合剂量为60 Gy 组放疗的近期疗效最佳（P ＜0．05），且60 Gy 组放射性肺炎的发生率较低剂量组高（P ＜0．05），而骨髓抑制、皮疹及腹泻的发生率比较差异无统计学意义（P ＞0．05）。所有毒副反应均为Ⅰ—Ⅱ级，经对症治疗后均能得到明显改善，并能顺利地完成全程治疗。结论吉非替尼联合高剂量放疗对晚期 NSCLC 的疗效更好，且剂量为60 Gy 也能耐受，但高剂量较低剂量毒副反应更大。
目的：觀察吉非替尼聯閤三維適形放療治療晚期非小細胞肺癌（NSCLC）的近期療效及毒副反應，併探索放療時的最高耐受劑量。方法按放療總劑量的不同，將32例晚期 NSCLC 分為54、56、58、60 Gy 組（各組的放療總劑量分彆為54、56、58、60 Gy），每組8例。照射區域為原髮竈和縱膈纍及淋巴結，同時每日口服吉非替尼250 mg 直到放療結束後第60天，放療前及放療結束後1箇月進行胸部 CT 檢查。療效和毒副反應分彆採用 RECIST 標準、CTCAE 3．0進行評價。結果高劑量放療組較低劑量組近期療效更好，即吉非替尼聯閤劑量為60 Gy 組放療的近期療效最佳（P ＜0．05），且60 Gy 組放射性肺炎的髮生率較低劑量組高（P ＜0．05），而骨髓抑製、皮疹及腹瀉的髮生率比較差異無統計學意義（P ＞0．05）。所有毒副反應均為Ⅰ—Ⅱ級，經對癥治療後均能得到明顯改善，併能順利地完成全程治療。結論吉非替尼聯閤高劑量放療對晚期 NSCLC 的療效更好，且劑量為60 Gy 也能耐受，但高劑量較低劑量毒副反應更大。
목적：관찰길비체니연합삼유괄형방료치료만기비소세포폐암（NSCLC）적근기료효급독부반응，병탐색방료시적최고내수제량。방법안방료총제량적불동，장32례만기 NSCLC 분위54、56、58、60 Gy 조（각조적방료총제량분별위54、56、58、60 Gy），매조8례。조사구역위원발조화종격루급림파결，동시매일구복길비체니250 mg 직도방료결속후제60천，방료전급방료결속후1개월진행흉부 CT 검사。료효화독부반응분별채용 RECIST 표준、CTCAE 3．0진행평개。결과고제량방료조교저제량조근기료효경호，즉길비체니연합제량위60 Gy 조방료적근기료효최가（P ＜0．05），차60 Gy 조방사성폐염적발생솔교저제량조고（P ＜0．05），이골수억제、피진급복사적발생솔비교차이무통계학의의（P ＞0．05）。소유독부반응균위Ⅰ—Ⅱ급，경대증치료후균능득도명현개선，병능순리지완성전정치료。결론길비체니연합고제량방료대만기 NSCLC 적료효경호，차제량위60 Gy 야능내수，단고제량교저제량독부반응경대。
ABSTRACT:Objective To investigate the short-term and toxic effects of gefitinib combined with three-dimensional conformal radiotherapy on advanced non-small-cell lung cancer(NSCLC),and to explore the maximum tolerated dose of radiotherapy.Methods Thirty-two patients with ad-vanced NSCLC were randomly assigned to receive three-dimensional conformal radiotherapy at dose of 54,56,58 or 60 Gy,with 8 patients in each group.The irradiated area included primary le-sions and mediastinal lymph nodes.In addition,patients were daily given oral gefitinib 250 mg un-til the 60th days after termination of radiotherapy.Chest CT was performed before radiotherapy and 1 month after termination of radiotherapy.The curative efficacies and toxic reactions were e-valuated using RECIST and CTCAE 3.0,respectively.Results High-dose radiotherapy(60 Gy) resulted in better short-term efficacy and lower incidence of radiation pneumonia than low-dose radiotherapy(54,56 or 58 Gy)(P <0.05).There were no significant differences in the incidences of myelosuppression,rash and diarrhea among the four groups(P >0.05).All toxic reactions were identified as grade Ⅰ-Ⅱ and were relieved by symptomatic treatment.Moreover,all patients suc-cessfully completed the treatment.Conclusion Gefitinib combined with high-dose radiotherapy has better efficacy in the treatment of advanced NSCLC,and high irradiation dose(60 Gy)can be tolerated by patients.However,high-dose radiotherapy increases toxic reactions compared with low-dose radiotherapy.
