Ⅲ期NSCLC化疗加前程累及野后程适形放疗的临床研究

Clinical trial of pre-course involved field and late course conformal radiation therapy combined with chemotherapy for Ⅲ non-small cell lung cancer

目的:观察前程累及野后程适形放疗联合健择/去甲长春花碱加顺铂(GP/NP)方案化疗治疗Ⅲ期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效.方法:64例NSCLC前瞻性随机分成对照组和试验组,各32例,均同时放、化疗.对照组用EP方案化疗(依托泊苷100 mg/m2,d1～d3;顺铂30 mg/m2,d1～d3),21 d为1个周期,放疗采用常规外照射,DT 2 Gy/次,每周5次,总DT 50～60 Gy.试验组用GP/NP方案化疗(健择1 000 mg/m2,d1、d8;去甲长春花碱25 mg/m2,d1、d8;顺铂30 mg/m2,d1～d3),21 d为1个周期,放疗采用前程累及野后程适形放疗,DT 1.8～2.0 Gy/次,每周5次,总DT 55～64 Gy.结果: 对照组总有效率56.3%(18/32),试验组总有效率87.5%(28/32),1、2年生存率分别为37.5%(12/32)、21.9%(7/32)和71.9%(23/32)、46.9%(15/32),差异有统计学意义,χ2=4.62,P=0.030.结论:前程累及野后程适形放疗联合GP/NP方案化疗治疗Ⅲ期NSCLC有较好疗效,其远期疗效须进一步观察.

OBJECTIVE： To evaluate the effect of pre-course involved field and late course conformal radiation therapy combined with GP/NP chemothempy on stage Ⅲ non-small cell lung carcinoma （NSCLC）. METHODS： 64 NSCLC patients were randomizedly divided into control group and experimental group. All patients received radiotherapy plus concurrent chemotherapy. The patients in control group received chemotherapy with Vp-16 （100 mg/m^2 ,dl - d3）and DDP （30 mg/m^2, d1- d3 ）, with one cycle lasting 21 days. Radiotherapy was given with conventional fraction in 2 Gy per fraction and five fractions per week. The total tumor doses were 50-60 Gy. The patients in experimental group received chemotherapy with GEM （1 000 mg/m^2, d1 ,d8）/NVB（25 mg/m^2, d1 ,d8）and DDP （30 mg/m^2,d1-d3 ）, with one cycle lasting 21 days. Radiotherapy was given with pre-course involved field and late course conformal radiation therapy in 1.8- 2 Gy per fraction and five fractions per week. The total tumor doses were 55- 64 Gy. RESULTS： The overall response rate was 56.3% in control group and 87.5% in experimental group. The 1-, 2-year survival rates were 37.5%, 21.9% and 71.9%, 46.9% in control group and in experimental group（X^2= 4.62,P = 0. 030）. CONCLUSIONS： Pre-course involved field and late course conformal radiation therapy combined with GP/NP chemothempy on stage Ⅲ non-small cell lung carcinoma is better than conventional radiotherapy, Long term results need further follow-up.