本文選題：局部晚期非小細(xì)胞肺癌　切入點(diǎn)：誘導(dǎo)化療　出處：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:1.通過Meta分析對比不可手術(shù)局部晚期非小細(xì)胞肺癌患者經(jīng)誘導(dǎo)化療后同期放化療與同期放化療兩種治療模式的療效和安全性差異。2.對我院局部晚期非小細(xì)胞肺癌經(jīng)誘導(dǎo)化療后同期放化療治療模式下的近、遠(yuǎn)期療效及治療不良反應(yīng)進(jìn)行評價(jià),了解此治療模式優(yōu)勢、不足之處,探討其臨床可行性。方法:1.計(jì)算機(jī)檢索The Cochrane Library、Pub Med、Embase、Web of Science、CBM、CNKI數(shù)據(jù)庫,同時(shí)輔佐其他檢索途徑,搜集近15年有關(guān)局部晚期非小細(xì)胞肺癌誘導(dǎo)化療后同期放化療與同期放化療治模式的隨機(jī)對照試驗(yàn)。質(zhì)量評價(jià)參考Cochrane質(zhì)量評價(jià)標(biāo)準(zhǔn),統(tǒng)計(jì)學(xué)分析應(yīng)用Review Manager 5.2軟件。2.回顧性研究2007年1月至2016年1月遵義醫(yī)學(xué)院附屬醫(yī)院初治的52例不可手術(shù)的局部晚期非小細(xì)胞肺癌(NSCLC)患者,治療模式均為誘導(dǎo)化療加同期放化療,放療采用三維適形調(diào)強(qiáng)放療(IMRT)。治療結(jié)束后按照RECIST1.1標(biāo)準(zhǔn)進(jìn)行評估療效,毒副反應(yīng)按照WHO毒副反應(yīng)評價(jià)標(biāo)準(zhǔn)進(jìn)行評價(jià)。觀察患者的治療后完全緩解(CR)、部分緩解(PR)、病情穩(wěn)定(SD)、病情進(jìn)展(PD)、1、2、3、5年總生存率(OS)及治療期間不良反應(yīng)情況。結(jié)果:1.Meta分析結(jié)果顯示近期療效:總有效率差異無統(tǒng)計(jì)學(xué)意義(OR=1.30,95%CI:0.96~1.77,P=0.10);遠(yuǎn)期療效:1年生存率、2年生存率差異無統(tǒng)計(jì)學(xué)意義(OR=1.51,95%CI:0.97~2.43,P=0.07)、(OR=1.34,95%CI:1.00~1.79,P=0.05),3年生存率差異具統(tǒng)計(jì)學(xué)意義(OR=1.43,95%CI:1.02~2.01,P=0.04);Ⅲ~Ⅳ級毒副反應(yīng):放射性食管炎、白細(xì)胞降低差異有統(tǒng)計(jì)學(xué)意義(OR=1.96,95%CI:1.06~3.62,P=0.03)、(OR=1.84,95%CI:1.24~2.74,P=0.002);放射性肺炎、惡心、嘔吐差異無統(tǒng)計(jì)學(xué)意義(OR=1.31,95%CI:0.62~2.77,P=0.48)、(OR=1.46,95%CI:0.82~2.59,P=0.19)。2.我院回顧性研究結(jié)果顯示全組患者中位生存時(shí)間為24個(gè)月,1、2、3及5年OS分別為80.8%、50.8%、38.0%及9.5%�？偡磻�(yīng)率為86.5%。3-4級不良反應(yīng)發(fā)中,白細(xì)胞降低者占32.7%;血小板下降2%;血紅蛋白降占2%,惡心、嘔吐者占5.8%;放射性食管炎占5.8%,放射性肺炎占13.5%。結(jié)論:Meta分析結(jié)果顯示誘導(dǎo)化療后同期放化療雖Ⅲ~Ⅳ級毒性反應(yīng)稍增多,但3年生存率療效較同期放化療提高,我院回顧性研究結(jié)果顯示誘導(dǎo)化療后同期放化療毒性反應(yīng)可接受,是安全有效的治療手段。此治療方法近期療效明確,遠(yuǎn)期療效可觀,但仍需開展大樣本臨床試驗(yàn)證實(shí)。
[Abstract]:Purpose 1.Meta analysis was used to compare the efficacy and safety of two modes of radiotherapy and chemotherapy after induction chemotherapy and simultaneous radiotherapy and chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). 2.To evaluate the near and long term curative effect and adverse reaction of local advanced non-small cell lung cancer treated with radiotherapy and chemotherapy after induction chemotherapy, to understand the advantages and disadvantages of this treatment model, and to explore its clinical feasibility.Method 1: 1.To search the The Cochrane Library The Medbase Web of CBMN CNKI database and assist other retrieval approaches, a randomized controlled trial was conducted in the past 15 years on the simultaneous radiotherapy and chemotherapy of locally advanced non-small cell lung cancer (NSCLC) after induction chemotherapy.The quality evaluation referred to Cochrane quality evaluation standard, and applied Review Manager 5.2 software. 2. 2.From January 2007 to January 2016, 52 cases of non-operative NSCLC patients with locally advanced non-small cell lung cancer (NSCLC) treated in affiliated Hospital of Zunyi Medical College were studied retrospectively. All the patients were treated by induction chemotherapy plus concurrent radiotherapy, and three dimensional conformal intensity modulated radiotherapy (IMRTT) was used for radiotherapy.The curative effect was evaluated according to RECIST1.1 standard and the side effects were evaluated according to WHO criteria after treatment.To observe the complete remission, partial remission, stable SDI, the overall 5-year survival rate and the adverse reaction during the treatment.緇撴灉:1.Meta鍒嗘瀽緇撴灉鏄劇ず榪戞湡鐤楁晥:鎬繪湁鏁堢巼宸紓鏃犵粺璁″鎰忎箟(OR=1.30,95%CI:0.96~1.77,P=0.10);榪滄湡鐤楁晥:1騫寸敓瀛樼巼,2騫寸敓瀛樼巼宸紓鏃犵粺璁″鎰忎箟(OR=1.51,95%CI:0.97~2.43,P=0.07),(OR=1.34,95%CI:1.00~1.79,P=0.05),3騫寸敓瀛樼巼宸紓鍏風(fēng)粺璁″鎰忎箟(OR=1.43,95%CI:1.02~2.01,P=0.04);鈪鈪ｇ駭姣掑壇鍙峉hould: radiation esophagitis,The results of retrospective study in our hospital showed that the median survival time of the whole group was 24 months and 5 years OS was 80.8% and 50.8%, 38.0% and 9.5%, respectively.The total reaction rate was 86.5.3-4 grade adverse reactions, the leukopenia accounted for 32.772; the platelets decreased 2; the hemoglobin decreased 2, the nausea and vomit 5.8. the radiation esophagitis accounted for 5.8and the radiation pneumonia 13.5.ConclusionThe results of meta-analysis showed that the 3-year survival rate was higher than that of chemoradiotherapy in the same period, although the toxic reactions of grade 鈪，

本文編號：1721357