| Objective: To observe the effects of 3-dimensional conformal ra-diotherapy(3D-CRT) in combined modality therapy for stageâ…¢non-s-mall cell lung cancer(NSCLC), estimate the response rate, free surviv-al time and survival rate, analyze adverse reaction.Methods: Between December 2003 and June 2008, 71 cases that have complete followed-up data with stageâ…¢of NSCLC received ra-diotherapy in the first affiliated hospital of Dalian medical university.The disease was StageIIIA in 39, StageIIIB in 32, squamous-celled c-arcinoma in 40 ,adenocarcinoma in 21, adenosquamous Carcinoma in 7,Large Cell Carcinoma in 2 and carcinoma sarcomatodes in 1.These c-ases were divided into two groups randomly: in group A, 34 patients received chemoradiotherapy, in group B, 37 patients received operationplus chemoradiotherapy. All patients received 3D-CRT with high ener-gy X-ray. Normo-fractionated radiotherapy,1.8~2.0Gy/fraction, 5/fraction/week. The prescribe doses of chest radiation field in group A were60~65Gy. In cases that had excellent conformal the prescribe doses cou-ld be 70 Gy.The course of treatment was 6~7 weeks. The cases with supraclavicular lymph nodes metastasis were given the fields of supra-clavicular metastatic lymphatic region. The field was given irradiationwith X-ray first, the total dose was 40~45Gy, then it received irradia-tion with high-energy electron to a total doses of 60~65Gy. Patients with adjuvant radiotherapy, the prescribe dose of target volume was50Gy, but to the cases whose cutting edge were male,the dose added to55~60Gy. The course of treatment was 5~6 weeks. All patients receiv- ed sequential chemoradiotherapy for 2~6 cycles. Combination chemoth-erapy included TP, GP and NP. Two issues were assessed by usingDo-se volume histogram: dose delivered to Target Volume and normal tis-sues nearby. The Kaplan-Meier method was used to calculate the ove-rall survival rate. Acute and late toxicities were graded according to RTOG/EORTC radiation morbidity scoring criteria.Results: With a median followed-up of 25.5 months to May 2009, the response rate(CR plus PR)of group A was 52.9%. With long-term following up, In group A, the median overall survival time was 16.5 months, the1-,2-,3-year overall survival rates were 68%, 28% and 10% respectively. In group B, the median overall survival time was 34.6 months, the median progression-free survival time(PFS) was 22.3 months, the1-,2-,3-year survival rates were 95%, 81% and 47%. The major toxicity were radioactive esophagitis and pneumonia. The incidence rate of esophagitis was 38%(27/71) and usually occurred in 2~6 weeks after radiotherapy (degree I and II, and no degree III). The incidence rate of acute radioactive pneumonia was 23.9%(17/71) and occurred in 3~6 weeks when radiotherapy proceed (usually degree I and II, degree III in one case). It got better after therapy. By reviewing at 6 months after radiotherapy and following up long-term radioactive pulmonary injury, the rate of occurring iconographic change was 38%(all averaging below Degree II).More than half of patients in group B occurred progression in 2 years. The main reason of progression in group A and B was distant metastasis. The metastatic rate was 76.2%. The main reason of death was nonfunction of multiple organs induced by distant metastasis.Conclusion:1. Combined Modality Therapy should be the main therapy of stageâ…¢non-small cell lung cancer(NSCLC).2. 3-Dimensional conformal radiotherapy(3D-CRT) can increase the effective rate of inoperable patients and it is an effective adjuvant therapy. Furthermore, no apparent toxicity is increased.3. The major toxicity of 3-Dimensional conformal radiotherapy were radioactive esophagitis and pneumonia. However, all the toxicity can be tolerated and got better after treatment; 4. 3-Dimensional conformal radiotherapy(3D-CRT) can decrease the dose delivered to normal tissues nearby, while increase the dose in target volume. Survival rate could be raised by 3D-CRT. The development potential of 3D-CRT is excellent.
|
PDF Full Text Request