| Objectives:This study aimed to analyze the clinical characteristics of patients with inoperable locally advanced non small cell lung cancer, and discuss the recent curative effect and adverse reactions on chemoradiotherapy, and the recent curative effect of different dose of radiation therapy.Methods:We retrospectively reviewed the medical records of stage IIIA or stage IIIB LA NSCLC patients who confirmed by pathological histology and imaging examination results in the third affiliated hospital of Kunming medical university between 01 January 2007 and 30 September 2015.Survey included:patients’ age, gender, smoking, pathological type, lesion location, disease stage, radiotherapy techniques and dosage, chemotherapy regimens, the time of radiation and chemotherapy treatment, efficacy evaluation and adverse reactions and so on.Analyzed and compared the recent curative effect of concurrent chemoradiotherapy and sequential chemoradiotherapy and the recent curative effect of different radiotherapy dose group, and observed the adverse reactions. Statistical methods used SPSS 17.0 statistical software for data processing, the comparison of count data by chi-square test or Fisher exact probability method.Results:1.208 patients in inoperable LA NSCLC were included in the analysis, the age was 35-78 years, the median age was 60 years;the central type lung cancer was 165 patients (79%), peripheral lung cancer was 43 cases (21%);squamous carcinoma in 157 cases (75%),35 cases of adenocarcinoma (17%),and other 16 cases (8%),the squamous carcinoma was the main pathological type;stage IIIA was 80 cases (38%), stage ⅢB was 128 cases (62%),stage IIIB was more than stage IIIA.In the study,62 patients (30%) in concurrent chemoradiotherapy,146 patients (70%) in sequential chemoradiotherapy, of which 142 patients (68%) were treated with 3D-CRT,66 patients (32%) were treated by IMRT treatment;all patients adopted conventional fractionation radiotherapy (2.0Gy/F),radiation dose was 50-74Gy,the median radiation dose was 60 Gy,27 patients (13%) of the radiation dose were lower than 60 Gy,87% of patients with radiation dose was more than 60 Gy.2.The effective rate in Sync group was 76%, sequential group was 60%, the recent curative effect of the difference was statistically significant between the two groups (P = 0.032).The effective rate in 3D-CRT and IMRT combined concurrent chemotherapy was 81% and 69%,respectively,the recent curative effect of the difference was not statistically significant between the two groups(P=0.475).In 3D-CRT combined concurrent chemotherapy,the treatment effectivene of low dose group(60-64Gy), middle dose group(66-68Gy) and high dose group(70-74Gy) was 78%,86% and 80%,respectively,the recent curative effect of the difference between three groups had no statistical significance.In IMRT combined concurrent chemotherapy,the treatment effectivene of low dose group(60-64Gy) and middle dose group(66-68Gy) was 78% and 57%,respectively,the recent curative effect of the difference between two groups had no statistical significance (P=0.596).3.105 of 146 sequential chemoradiotherapy LA NSCLC patients used 3D-CRT technology,the treatment effectivene of low dose group(60-64Gy), middle dose group(66-68Gy) and high dose group(70-72Gy) was 53%,68% and 90%,respectively, the difference of the curative effect between low dose group and high dose group was significant statistically(P=0.003).41 of 66 IMRT treatment in LA NSCLC patients used sequential chemoradiotherapy,18 cases of the radiation dose were lower than 60 Gy were ruled out,therefore, only 23 patients were included in the analysis,the treatment effectivene of low dose group, middle dose group and high dose group was 46%,63% and 50%.respectively, the difference of the curative effect between three groups had no statistical significance.4.1 case appeared treatment-related deaths (big haemoptysis), only 10 patients had III to IV degree adverse reactions, the incidence was 5%, mainly in bone marrow suppression.Adverse reactions included digestive tract reaction,bone marrow suppression (mainly for white blood cells reduce),radioactive esophagitis,radioactive pneumonia, radioactivity skin damage, haemoptysis,among which the digestive tract reaction, radioactive pneumonia and radioactivity skin damage was the most common.Conclusions:1.The recent curative effect of concurrent chemoradiotherapy was superior to sequential chemoradiotherapy in inoperation LA NSCLC patients.2.The disease control rates of concurrent chemoradiotherapy by IMRT was less than 3D-CRT, but the difference was not significant statistically.3.The recent curative effect of the different radiotherapy dose of 3D-CRT and IMRT combined concurrent chemotherapy were similar.4.In 3D-CRT combined sequential chemotherapy, the radiotherapy dose which was more than 70 Gy had a better curative effect.5.The recent curative effect of different radiotherapy dose in IMRT combined sequential chemotherapy group were similar.6.The adverse reactions of LA NSCLC patients with radiation and chemotherapy treatment could be tolerated. |
PDF Full Text Request