Late-course high-dose radiotherapy combined with concurrent chemotherapy for locally advanced non-small cell lung cancer / 肿瘤研究与临床

ABSTRACT

Objective To evaluate the effect and patient 's tolerance on late-course high-dose radiotherapy (LCHDRT) combined with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC).Methods 73 NSCLC patients were entered into this study from May 2000 to May 2006.The treatment regime consisted of conventional radiotherapy first (40 Gy,20 f,4 w),followed by LCHDRT (24-30 Gy,6 f,2 w,tumor α/β =10 Gy,BED =81.6-93 Gy) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,hilum of lung and mediastinal lymph drainage region.LCHDRT focused on the primary lesion only,with ≥95 ％ isodose curve covering the planning target volume (PTV) and the target dose was prescribed to PTV.Supraclavicular metastases lymph node was treated by 6 MV X-ray and electron beam to a total dose of 65-70 Gy.Chemotherapy regime consisted of vinorelbine (25 mg/m2,d1,8 iv) and cisplatin (30 mg/d,d1-3,iv gtt) in the lst and 5th weeks.Results Leukopenia and radiation-induced pneumonitis,as shown by the WHO staging system were the most common acute toxicities.In V20≤25 ％,17.2 ％ (5/29) patients happened radiation-induced pneumonitis only.But in V20 ＞ 25 ％ and ≤ 30 ％,65.9 ％ (29/44) happened radiation-induced pneumonitis (x2 =16.63,P ＜ 0.01).It showed that patients accompany increment of V20,the happening rate of radiation-induced pneumonits probability was increased.The other acute toxicities such as nausea,fever,radiation-induced esophagitis,hemoglobin decrease and thrombocytopenia were mainly grade 1 or 2.After symptomatic treatment,all patients completed the planned treatment without interruption except 4 patients above 70 old years of grade 3 radiation-induced pneumonitis.Late lung radio-fibrosis was 34.3 ％ (25/73).Before the end of the second month after treatment,the complete response (CR) and partial response (PR) rates were 17.8 ％ (13/73) and 69.9 ％ (51/73),respectively,with CR+PR rate of 87.7 ％.The 1-,3-,5-year local control and overall survival rates as monitored by the x2 test method were 82.2 ％,60.3 ％,50.7 ％ and 57.5 ％,23.3 ％,13.7 ％,respectively.Conclusion LCHDRT combined with concurrent chemotherapy shows a promising results,but the rational time-dose-fraction model still need further observation.