30例Ⅲ期非小细胞肺癌交替治疗的疗效观察

The Alternative Therapy of Chemotherapy and Radiotherapy on Moderate and Advanced(Stage Ⅲ)Non-small Cell Lung Cancer

目的:观察化疗+放疗+化疗的交替治疗方式,在Ⅲ期非小细胞肺癌中的临床疗效。方法:57例Ⅲ期非小细胞肺癌随机分为交替治疗组与单纯放疗组。交替治疗采用顺铂为主的联合化疗,至少完成2个周期。放疗采用常规方式,总量55～65Gy/5～6周。治疗第4周和治疗结束4～8周内复查胸片、CT。结果:交替治疗组CR36.7%(11/30)、PR43.3%(13/30)、NR16.7%(5/30)、PD3.3%(1/30)。单纯放疗组CR22.2%(6/27)、PR29.6%(8/27)、NC40.7%(11/27)、PD7.4%(2/27)。交替治疗组有效率(CR+PR)为80.0%,显著优于单纯放疗组51.9%(χ2=5.067,P=0.02)。1、2、3年生存率,交替治疗组为67.3%、18.6%、14.1%,放疗组为48.2%、14.7%、4.1%。交替治疗组3年生存率显著优于单纯放疗组(P<0.01)。交替治疗中位生存期16个月、较单纯放疗中位生存期11个月提高5个月。交替治疗与常规放疗的骨髓抑制分别为73.3%(22/30,其中Ⅲ级36.2%)、37.0%(10/27),交替治疗组的骨髓抑制显著高于单纯放疗组(P<0.05)。结论:交替治疗对Ⅲ期非小细胞肺癌有效,不良反应轻,多数患者可以耐受,在改善生存质量同时,部分提高了生存时间。

To observe the effect of alternative chemotherapy （cisplatin and etoposide ） with radiotherapy on moderate and advanced （stage Ⅲ） non-small cell lung cancer. Methods： Fiftyseven patients with moderate and advanced stage （Ⅲ） non-small cell lung cancer were randomized into 2 groups, i.e. radiotherapy group （RT） and cisplatin, etoposide plus radiotherapy group （CF ＋ RT）. All patients in the groups received conventional radiotherapy. Patients in CF ＋ R group received combined chemotherapy with cisplatin （40mg, d 1-3）, etoposide （100 mg d 1-3） in the first and fourth weeks for at least 2 courses. In some patients, IFO or ADM was also given. Results： The complete response rate was 36.7% in CF ＋ RT group and 22.2% in R group. The 1-, 3- anti 5-year survival rate was 67.3%, 18.6% and 14.1% in CF ＋ RT group, anti was 48.2%, 14.7% and 4.1% in RT group, respectively. The median survival period was 11 months in RT group and 16 months in CT＋RT group. The major toxic reactions in CF ＋ RT group were grade Ⅰ-Ⅲ myelo-suppression （72.0%） and digestive tract reaction （57.0%）. Conclusion： Alternative chemotherapy （cisplatin and etoposide） with radiotherapy is preferable for the survival rate and CR＋PR rate in the stage-Ⅲ non-small cell lung cancer.