Weekly Docetaxol Combined With3d-crt In Patients For Stage Ⅲ Non-small Cell Lung Cancer

ObjectiveThe aim of this study is evaluating the therapeutic efficacy,survival rate and radiationcomplication of three dimensional conformal radiotherapy(3D-CRT） combined withweekly docetaxol for patients with stage Ⅲ non-small cell lung cancer(NSCLC)．Methods99patients with stage Ⅲ non-small cell lung cancer (including stage Ⅲ A and ⅢB)confirmed histopathologically and cytologically as stage Ⅲ.All the patients accepted1cycleor2cycles induction chemotherapy before radiochemotherapy. Induction chemotherapy wasemployed with TP regimen（docetaxol75mg/m2,cisplatin75mg/m2）.1Chemotherapy:Simultaneous chemoradiotherapy was employed with weekly-doseDocetaxol (35mg/m2)．All patients was preprocessed with dexamethasone(16mg,d1-3)one day before docetaxol．And these patients was treated with cimetidine400mg andpromethazine25mg half hour before docetaxol.2Radiotherapy:The involved-field radiation(IFR) with6MV-X ray or15MV-X raywas used with conventional fractionation，to a total dose of60Gy～66Gy．Eikonogen100ml intravenous bolus was used before scanning.The slice thickness was3mm～5mm.The Scan range was from cricoid cartilage to inferior margin of right adrenal gland.CT images were sent to Eclipse therapy planning system or Precise therapy planning systemfor contouring target volume and organ at risk. The treatment planning was established byradiation therapy physicists with3～5beams. Dose assessment by dose volumehistogram(DVH) to limit dose of normal tissue:bilateral lungs V20≤28%, spinal cord Dmax≤45Gy,heart V40≤30%, esophagus V45≤33%, brachial plexus Dmax≤66Gy.Prescriptiondose requests:110%PTV prescribed dose volume＜20%；115%PTV prescribed dosevolume＜5%；<93%PTV prescribed dose volume＜1%；90%～95%isodose contour surrounding90%～95%PTV.90%PTV accepting minimum absorbed dose.The radiationdose for stage T1～2was60Gy and stage T3～4was64～66Gy. Supraclavicular lymphaticmetastasis was treated with Cobalt-60gamma rays and12MeV electron rays, the dose sameto primary tumors.3Other treatments: Blood routine examination was monitored every week, hepatorenalfunction and water electrolyte metabolism monitored every2weeks. Whenleukocyte≤2.0×109, granulocyte colony-stimulating factor(G-CSF) was used.The dosage is5μg/kg/d with subcutaneous injection.The patients experienced2grade myelosuppressionduring induction chemotherapy should accept G-CSF prophylacticly,24～72hours afterchemotherapy,until granulocyte from minimum level to normal level or leukocyte10.0×109. When the patients presented with dysfunction of liver, diammoniumglycyrrhizinate was injected, until aminopherase to normal level. When presented radiationpneumonitis concomitant with fever, sputum culture plus drug sensitivity test should becarried out to select reasonable antibiotic, combined with cough suppressant and expectorant.When appearing radiation esophagitis, mucosal anaesthetic and glucocorticoid should beused.When leukocyte declining, general drug should be used, such as diyushengbaitablet,leucogen,batilol.Results1Completed status:All patients rceived the whole treatment course.There was no oneto terminate radiotherapy.There was only10patients not finishing6cycles weeklydocetaxol because of transient myelosuppression, radiation pneumonitis and radiationesophagitis.The median radiotherapy time of duration was43days（±2days）,and medianradiotherapy dose62Gy（60Gy～66Gy）.2Evaluation of therapeutic efficiency: Complete remission13cases（13.1%），partialremission35cases（35.4%），stable disease24cases（24.2%），progress disease17cases（17.2%），death7cases（7.1%），loss to follow-up3cases（3.0%）.The response rate(CR+PR) was48.5%, disease control rate(CR+PR+SD) was72.7%.3Survival analysis: The follow-up time was6.5～38.4months, median follow-up time22.4months. The median time to progression was11.3months (95%CI:8.3～14.7months）,median survival time18.6month（s95%CI:14.0～23.2months）.The1year survival rate was77.8%,2year survival rate57.6%,3year survival rate33.3%（P=0.04）.4Toxicity:The major toxicity was radiation esophagitis, nausea， radiation pneumonitis.But there was no severe toxicity to limit the radiotherapy course.The mostcommon toxicity was radiation esophagitis,grade1～2:52.5%（52/99）, grade3:12.1%(12/99). The second common toxicity was nausea, grade1～2:32.3%（32/99）,grade3:3.0%(3/99).The risk of radiation pneumonitis was relatively low, grade1～2:10.1%（10/99）, grade3:1.0%(1/99), grade4:1.0%(1/99).The incidence of othertoxicity was very low. such as mucositis, dysphagia, diarrhea, fever, leukocytopenia,thrombocytopenia, skin toxicity.ConclusionsConcurrent weekly docetaxel and radiotherapy was feasible in the treatment of stage ⅢNSCLC and acceptable for normal tissue complication．The time to progression and mediansurvival time had achieved anticipated goal. This is worthy of further clinical promotion andlaunching large-scale randomized controlled trial (RCT).