紫杉醇和顺铂同步放化疗治疗局部晚期非小细胞肺癌的临床分析

Concurrent chemoradiation therapy with cisplatin and paclitaxel for locally advanced non-small cell lung cancer

目的探讨常规剂量紫杉醇和顺铂同步放化疗治疗局部晚期非小细胞肺癌的疗效。方法42例ⅢA和ⅢB期的非小细胞肺癌患者,采用常规放疗,肿瘤量60 Gy,在放疗的第1、4周给予紫杉醇(135 mg/m2)和顺铂(70 mg/m2)方案化疗2个疗程。结果完全缓解2例,部分缓解30例,总有效率为76.2%。中位生存期18个月,1、2、3年生存率分别为64.3%、30.2%、12.0%。中位疾病稳定时间12个月,1、2、3年无复发生存率分别为48.1%、21.4%、5.7%。14例局部区域复发,10例远处转移,同时局部区域复发和远处转移5例;ⅢB期复发转移较ⅢA期多见。主要剂量限制性毒性为3、4级粒细胞下降和放射性肺炎。结论常规剂量紫杉醇和顺铂同步放化疗副作用可以耐受,有望提高局部晚期非小细胞肺癌的疗效。

Objective To evaluate the efficacy of concurrent systemic routine dose of paclitaxel/cisplatin combined with conventional thoracie irradiation in locally advanced non-small cell lung cancer（NSCLC）. Methods Forty-two unresectable stage Ⅲ A and Ⅲ B NSCLC patients were entered into this study. All patients received conventional thoracic irradiation to a total dose of 60 Gy within 6 weeks, with concurrent paclitaxel 135 mg/m^2, d1, and cisplatin 75 mg/m^2 in the first and fourth week of radiotherapy. Results The complete response（CR） and partial response （PR） was 2/42, and 30/42 patients, with an overall response rate of 76.2% and a median survival time of 18 months. The 1-, 2-, and 3-year survival rate was 64.3% ,30.2% ,12.0% ,respectively. The 1-, 2-, and 3-year progression-free survival rates was 48.1%, 21.4% ,5.7%, with a median progression-free survival of 12 months. Fourteen patients failed only locoregionally, 10 in distant metastastasis only and 5 in both. The locoregional/distant failure rate was higher in stage Ⅲ B than in stage ⅢA （ P 〈 0.05）. Grade 3/4 granulo-cytopenia and radiation pneumonitis were the dose-limiting toxicities. Conclusions Concurrent chemoradiation therapy with cisplatin and paclitaxel is tolerable and gives promising results in the treatment of locally advanced non-small cell lung cancer.