| Objective: To evaluate the effect and toxicity of concurrent chemo-radiotherapy for non-small cell lung cancer , to analyze the clinical factors and treatment parameters as predictors of survival rate and radiation toxicity in the treatment.Methods: From September 2006 to December 2008,52 patients with non-small lung cancer were eligible for the analysis. The median age was 62 years (range 30～74 years), There are 43 males, 9 females; 35 patients with squamous carcinoma, 13 with adenocarcinoma, 4 with adenosquamous carcinoma; 40 patients were central type and 12 were peripheral type ; 29 patients with stageⅢa and 23 with stage IIIb. Among of stage IIIb patients there were 3 with stage T4N3, 14 with stage T4 and 6 with stage N3. The radiation therapy used three dimensional-conformal radiotherapy, radiotherapy was delivered in 1.8~2Gy per fraction, 5 fractions per week, to a total dose of 60Gy. Concurrent chemotherapy consisted of two 28-day cycles of vinorelbine (NVP) 25mg/m2 infused at day1, 8 with cisplatin (DDP) 60～80mg/m2 infused at day 2～4. Consolidation chemotherapy with the same schema were given by 1～2 cycles after concurrent chemoradiotherapy. Toxicity, short time effects and survival rate were evaluated during and after the chemoradiotherapy treatment .Result: The final follow-up date was on December 1, 2008. The follow-up rate was 100%. All of 52 patients completed the three dimensional-conformal radiotherapy on schedule with total radiation time of 40-50 days. 7 patients (13.5%) received 4 cycles of chemotherapy, 19 patients (36.5%) received 3 cycles of chemotherapy , 10 patients (19.2%) received 2 cycles of chemotherapy and 16 patients (30.8%) received only 1 cycle of chmotherapy. There were 5 patients (9.6%) received complete remission, 40 patients (76.9%) received partial remission, the overall response rate was 86.5%. The one and two years locally control rates were 96.43%, 73.79%, respectively. The median survival time was 16 months, and the one and two years overall survival rates were 61.58%, 39.59%, respectively. 24 patients died, and of them ,12 patients (50%) died of distant metastases. The result of a further analysis showed that pre-treatment weight loss and stage T4 were the influential factor of survival rate. The leucocytopenia rate was 92.3%:15 patients were grade 1 (28.8%), 14 patients were grade 2 (26.9%), 17 patients were grade 3 (32.7%) and 2 patients were grade 4 (3.8%). 49 (94.2%) patients developed radiation pneumonitis: 22 (42.3%) patients were grade 1, 18 (34.6%) patients were grade 2, 7 (13.5%) patients were grade 3, 2 (3.8%) patients were grade 4. The correlative factors of radiation pneumonitis included GTV, CTV, PTV volume, mean lung dose (MLD), V5, V10 and the cycles of chmotherapy with Spearmen correlative analysis. Then by multivariate analysis lung V5≥53% was found as an independently hazard factor for over grade 2 radiation pneumonitis. 44 (84.6%) patients developed radiation esophagitis: 16 (30.8%) patients were grade 1, 12 (23.1%) patients were grade 2, 16 (30.8%) patients were grade 3, there was no grade 4 radiation esophagitis developed. By Spearmen correlativ analysis the correlative factors of radiation esophagitis included mean esophagus dose ,the LETT40, LETT45, LETT50, LETT55, LETT60, V40, V45, V50, V55, V60. Only esophagus V55≥26% was an independently hazard factor for over grade 2 radiation esophagitis by further multivariate analysis.Conclusion: Three dimensional conformal radiotherapy combining with concurrent chemotherapy of NP for locally advanced non-small-cell lung cancer can achieve better effect. pre-treatment weight loss and stage T4 were the influential factors of survival rate. Hematology toxicity, Acute radiation pneumonitis and acute radiation esophagitis were the main toxicities .The treatment could be tolerated and could be used safely .
|
PDF Full Text Request