Induction Chemotherapy With Gemcitabine Followed By Radiotherapy In Non-small Cell Lung Cancer

Objective and Background:Lung cancer has a high morbidity and mortality in the world. More than 85% of these patients belong to the non-small cell lung cancer (NSCLC) histopathologic subtype. Over the years people have been looking for radiosensitization substances which can improve the efficacy of radiotherapy. There are two types of material are considered to have some clinical value, a class of cells to repair inhibitors and imidazole hypoxic cell sensitizer. Gemcitabine (GEM) is a synthetic drug similar to cytarabine, with significant cytotoxicity and radiosensitization effect, which can effectively improve the clinical outcome of radiotherapy for NSCLC. Although many preclinical studies have shown that gemcitabine has considerable radiosensitization, but this mode of treatment is also accompanied by severe lung toxicity. But those who used gemcitabine with non-small cell lung cancer whether could be used with thoracic radiotherapy, and radiotherapy-induced chest radiation pneumonitis occurred was still no clear conclusion. Therefore, this study was collected in January 2000-2014 in December Affiliated Tumor Hospital of Guangxi Medical University hospital treatment of 86 cases of non-small cell lung cancer sequential chemoradiotherapy with gemcitabine inpatients with clinical data were retrospectively analyzed to explore non-small cell lung cancer factors sequential gemcitabine for lung injury in rats and effects.Patients and Methods:86 patients of using gemcitabine sequential chemoradiation treatment of non-small cell lung cancer patients with clinical data collected. Radiation pneumonitis, esophagitis according to RTOG / EORTC acute radiation reaction score, radiotherapy and chemotherapy toxicity of cancer treatment response according to WHO toxicity evaluation. Factors Affecting radiation pneumonitis with univariate and multivariate logistic calculation time to progression and overall survival after treatment with the life table method, survival analysis and survival curves depicted using Kaplan-Meier method. P <0.05 was considered statistically significant.Results:pneumonitis incidence (22.1%), univariate analysis revealed that radiotherapy methods, conventional radiation therapy area, V20, V30 were statistical significant relative to the incidence of RP. multivariate annalysis revaled that V20 was the single independent predictor of RP.3-DCRT radiation pneumonitis incidence (14.3%) and2-DCRT pneumonitis incidence (36.7%) was significantly (P<0.05). Because 13 patients with RO postoperative chemoradiation line, I removed the short-term efficacy evaluation. The remaining 73 patients, complete remission CRO patients (0%), partial remission PR44 cases (60.3%), stable disease SD 22 cases (30.1%), disease progression PD 7 patients (9.5%). The median overall survival was 15 months, with a median time to progression was 6 months,1 year,2 years,3 years and 5-year survival rates were:85%,31%,17% and 5%,1 year progression-free survival rate was 35%. Conventional two-dimensional and three-dimensional conformal radiotherapy group, the median overall survival IMRT group and median progression-free survival was 13 months,16 months and 8 months,10 months, the difference was not statistically significance (P> 0.05). Vestiges of its side effects mainly as esophagitis (13.4%), bone marrow suppression in particular, thrombocytopenia (43%, of which 19.8% grade III-IV), liver and kidney dysfunction, etc., the symptomatic treatment can improve.Conclusion:l,Gemcitabine sequential chemoradiotherapy for non-small cell lung cancer in the occurrence of radioactive pneumonia with conventional radiation field area and three-dimensional conformal radiotherapy, intensity modulated radiotherapy of V20 has significant correlation, the 2 d radiation area is controlled below 179.5 cm2, the three dimensional conformal intensity modulated radiation therapy (imrt), V20 control within 27.5%, higher security, can provide optimal treatment plan for clinical reference.2, gemcitabine induced sequential radiotherapy within 4 cycles of chemotherapy treatmentof non-small cell lung cancer incidence of radioactive pneumonia in acceptable range, and between 1-4 cycles have no difference with incidence of radioactive pneumonia.3, gemcitabine sequential 3D-CRT and 2D-CRT in non-small cell lung cancer overall survival and progression-free surial has no obvious difference, but the former objective which is high efficacy and incidence of radioactive pneumonia was significantly lower than the latter.