| Objective: To observe the efficacy and the toxicity of the image-guided hypofractionated three-dimensional conformal radiotherapycombined with chemotherapy in the treatment of local advanced nonsmall cell lung cancer, and to evaluate the validity, the security and thefeasibility of this scheme.Method: From Sep.2009to Jun.2011,44patients (pts) with localadvanced non small cell lung cancer (Stage ⅢA:25pts, Stage ⅢB:19pts) were enrolled and divided into the test group (20pts) and the controlgroup (24pts). Image-guided three-dimensional conformal radiotherapywas used in all patients without elective nodal irradiation. Radiotherapyscheme: the test group:60Gy/12f,5Gy/f,5f/w, completed in2.3w, andthe control group:60~66Gy/30~33f,2Gy/f,5f/w, completed in6~6.5w.All patients were treated with concurrent and consolidationchemotherapies. Concurrent chemotherapy scheme: paclitaxel liposome(lipusu,45mg/m~2) was given by intravenous infusion (iv) on the first dayof each radiotherapy week. Consolidation chemotherapy scheme:1monthafter the completion of the concurrent chemoradiotherapy, lipusu(135~175mg/m~2) was given by iv in3h, d1, and, Cisplatin(20mg/m~2) wasgiven by iv, d1~5,21days for a cycle,2~4cycles in total. Treatments ofantiemetics, liver proction, nutritional support, et al, were given toprevent the toxic reaction. The short and remote effectiveness wereobserved. The acute and late toxicities were assessed. Statistical analysiswas completed in use of the SPSS19.0statistical software. Chi-squaretest or fisher probability method were used in the comparison of the ratio and the constituent radio interblock. Kaplan-Meier method was used incalculating the local control rate and the overall survival rate. Log-ranktest was used in survival analysis.Results:1Until Dec.31,2011, the median follow-up time was18.8months (6~27.5months), with follow-up rate of100%. All patients havecompleted the concurrent chemoradiotherapy.1patient in the test groupdidn't take the consolidation chemotherapy because of4degree bonemarrow depression,5pts underwent2cycles,5pts underwent3cycles,and9pts underwent4cycles. In the control group, there was1patientwho refused the consolidation chemotherapy after the concurrentchemoradiotherapy,1patient had no consolidation chemotherapy becauseof3degree bone marrow depression,4pts had2cycles,7pts had3cycles,and11pts had4cycles.2The short efficacy of the concurrent chemoradiotherapy: In the testgroup, the response rate(CR+PR) was90.0%(18/20), CR rate15.0%(3/20),PR rate75.0%(15/20),SD rate10.0%(2/20),no PD ones. In thecontrol group, the response rate was58.3%(14/24),CR rate8.3%(2/24),PR rate50.0%(12/24),SD rate33.3%(8/24),PD rate8.3%(2/24). ByChi-square test, there was significant difference between the responserates of the two groups (P<0.05).The efficacy after the consolidationchemotherapy: In the test and control group, the response rates were90.0%(18/20),62.5%(15/24), respectively. And there was alsosignificant difference between the two groups.3The efficacy of the consolidation chemotherapy: the effects beforeand after the consolidation chemotherapy of the test and control groupwhose patients had accepted the consolidation chemotherapy were89.5%vs.89.5%, and59.1%vs.63.6%, without significant differencesrespectively. And there was no significant difference between the effectsbefore and after the consolidation chemotherapy in all patients who takethe consolidation chemotherapy (73.2%vs.75.6%,P=0.800).(4) The remote efficacy:1-,2-year local control rates in the test group were87.3%,34.1%, respectively, and those in the control groupwere74.5%,20.3%respectively, with significant difference (P=0.040).The median survival, and1-,2-year survival rates of the two groups were24months,87.8%and43.9%vs.21.5months,77.8%and33.5%respectively, without significant difference (P=0.089).(5) Toxicity: Acute toxicity: The main acute toxic reactions werebone marrow depression (decrease of WBC mainly), minor (grade1,2)acute radiation pneumonitis and esophagitis. No serious acute radiationinjuries were observed. The incidence rates of bone marrow depression,radiation pneumonitis and esophagitis in the test and control group were75.0%vs.70.8%,50.0%vs.45.8%,40.0%vs.41.7%, respectively. Therewas no significant difference between the two groups (P>0.05). Latetoxicity: The main late toxic reactions were minor (grade1,2) lateradiation pneumonitis and esophagitis. The late radiation pneumonitis andesophagitis incidented in the two groups were40.0%vs.29.2%,15.0%vs.16.7%, respectively. There was no significant difference between the twogroups either(P>0.05).Conclusions:(1) The efficacy of the image guided hypofractionatedthree dimensional conformal radiotherapy combined with paclitaxelliposome concurrently was better than that of the conventionalfractionated one for the local advanced non small cell lung cancer. As oneof effective treatment schemes, the former scheme improved the localcontrol and had the tendency of prolonging the overall survival for thosepatients.(2) Consolidation chemotherapy did not enhance significantly theefficacy of the chemoradiotherapy for patients with the local advancednon small cell lung cancer, and the role of it needed further exploration.(3) The main toxicities of the concurrent chemoradiotherapyfollowed by the consolidation chemotherapy were minor bone marrowdepression and minor radiation injuries. And the hypofractionatedradiotherapy, at the same time in enhancing the biological effective dose, didn't increase the toxicities, which scheme improve the compliancebecause of its good tolerance. Thus, this scheme was safe and feasible.(4) Because of the smaller sample size of this study and the shorterfollow-up time, there may be misregistration in the consequences above.But the patients with LANSCLC got benefits from this scheme whichwas worth of enlarging the sample size and observing the remote efficacyand the late toxicity further more. |
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