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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (05) : 559 -563. doi: 10.3877/cma.j.issn.1674-6902.2017.05.011

所属专题： 文献；

论著

同步放化疗治疗局部晚期EGFR野生型NSCLC合并COPD患者的临床疗效观察
杜建飞1, 畅婕1, 崔立春1, 王旋1, 党升强1, 张双燕1, 杨拴盈2,†()   
  1. 1. 710016　西安，长安医院肿瘤科
    2. 710004　西安，西安交通大学第二附属医院呼吸科
  • 收稿日期:2017-05-02 出版日期:2017-10-20
  • 通信作者: 杨拴盈
  • 基金资助:
    国家自然科学基金资助项目(81350032); 陕西省科技统筹计划重点项目(2014KTCL03-02)

Outcomes of concurrent thoracic radiation with chemotherapy for EGFR wild-type local advanced non small cell lung cancer with COPD

Jianfei Du1, Jie Chang1, Lichun Cui1, Xuan Wang1, Shengqiang Dang1, Shuangyan Zhang1, Shuanying Yang2,†()   

  1. 1. Department of Oncology, Changan Hospital, Xi′an 710016, China
    2. Department of Respiratory Disease, Second Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710004, China
  • Received:2017-05-02 Published:2017-10-20
  • Corresponding author: Shuanying Yang
  • About author:
    Corresponding author: Yang Shuanying, Email:
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杜建飞, 畅婕, 崔立春, 王旋, 党升强, 张双燕, 杨拴盈. 同步放化疗治疗局部晚期EGFR野生型NSCLC合并COPD患者的临床疗效观察[J]. 中华肺部疾病杂志(电子版), 2017, 10(05): 559-563.

Jianfei Du, Jie Chang, Lichun Cui, Xuan Wang, Shengqiang Dang, Shuangyan Zhang, Shuanying Yang. Outcomes of concurrent thoracic radiation with chemotherapy for EGFR wild-type local advanced non small cell lung cancer with COPD[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(05): 559-563.

目的

探讨同步放化疗治疗局部晚期表皮生长因子受体(epidermal growth factor receptor, EGFR)野生型非小细胞肺癌(non-small cell lung cancer, NSCLC)合并慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)和肺不张患者的近期疗效及毒副反应。

方法

对42例局部晚期EGFR野生型NSCLC合并COPD和肺不张的患者给予低分割大剂量调强放射治疗，Dt：5Gy/次，隔日一次，3次/周，总剂量达到50～60Gy/10～12次，同步EP方案依托泊苷50 mg/m2 d1～5，顺铂d1～5(总量70 mg/m2)化疗，每四周为一周期，共化疗两周期后评估患者疗效。

结果

治疗结束后复查患者胸部CT评估患者肺部原发肿块及纵膈阳性淋巴结退缩情况完全缓解(complete remission, CR) 6例(14.3%)，部分缓解(partial remission, PR) 31例(73.8%)，稳定(stable disease, SD) 5例(11.9%)，进展(progressive disease, PD)0例；毒副反应情况：毒性反应主要表现为放射性肺炎，其中0级16例(38.1%)，Ⅰ～Ⅱ级21例(50%)，Ⅲ级5例(12%)。

结论

对于局部晚期EGFR野生型NSCLC合并COPD和肺不张的患者低分割调强放射治疗同步EP方案化疗安全有效，毒副反应可以耐受。

关键词: 同步放化疗, EGFR野生型, 局部晚期, 非小细胞肺癌, 肺疾病，慢性阻塞性
Objective

To explore the recent therapeutic effect and adverse reactions of chemoradiation for epidermal growth factor receptor(EGFR) wild-type LA-non-small cell lung cancer(NSCLC) patients with chronic obstructive pulmonary disease(COPD) and atelectasis.

Methods

42 patients receive hypofractionation Intensity-modulated radiotherapy, 5 Gy/ fraction, three times/week, total dose 50-60Gy/10-12fractions, Concurrent chemotherapy with etoposide 50 mg/m2 on days1 to 5 and cisplatin on days 1 to 5(total 70 mg/m2)every 4 weeks for two cycles.

Result

After treatment, 42 patients complete remission(CR) 6 cases(14.3%), partial remission(PR) 31 cases(73.8%), stable disease(SD) 5 cases(11.9%), progressive disease(PD) 0 case; Toxic effects mainly for radioactive pneumonia, of which the 0 level 16 cases (38.1%), Ⅰ-Ⅱ level 21 cases (50%), Ⅲ level 5 cases (12%).

Conclusion

hypofractionation Intensity-modulated radiotherapy Concurrent EP chemotherapy is effective and well-tolerated for EGFR wild-type LA-NSCLC patients with COPD and atelectasis.

Key words: Chemoradiation, EGFR wild-type, Local advanced, Non-small cell lung cancer, Chronic obstructive pulmonary disease
表1 42例肺癌合并COPD患者放化疗的近期疗效
疗　效 ≤5 cm(n＝25) >5 cm(n＝17) 合计(n＝42)
例数 构成比(%) 例数 构成比(%) 例数 构成比(%)
CR 3 12.00 3 17.65 6 14.29
PR 21 84.00 10 58.82 31 73.81
SD 1 4.00 4 23.53 5 11.90
PD 0 0.00 0 0.00 0 0.00
表2 患者治疗前后肺功能比较
组　别 例数 FEV1 FEV1/FVC DLCO VC FVC
治疗前 42 48.31±7.25 50.16±8.56 53.02±6.72 53.6±6.2 51.45±7.12
治疗后 42 67.24±6.32 66.21±5.23 67.23±7.01 67.4±6.45 66.82±5.85
P值 ? <0.05 <0.05 <0.05 <0.05 <0.05
表3 放射性肺炎发生率
级　别 例数 百分比(%)
0级 16 38.1
Ⅰ级 12 28.6
Ⅱ级 9 21.4
Ⅲ级 5 12
Ⅳ级 0 0
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