健择同步适形放射治疗Ⅲ期非小细胞肺癌的疗效观察

Efficacy of concurrent gemcitabine and radiotherapy for stage Ⅲ non-small cell lung cancer

目的:比较健择与铂类联合方案和健择单药同步适形放疗治疗Ⅲ期(nonsmallcelllungcancer,NSCLC)的疗效及耐受性。方法:回顾性分析55例行健择单用或联合用药与适形放疗结合治疗的Ⅲ期NSCLC患者,观察两种方案的近期疗效、放化疗毒副反应和生存率。结果:健择单用+放疗组(GRT)CR、PR和CR+PR分别为7%、70%和77%,联合用药+放疗组(GP/GCRT)CR、PR和PR+CR分别为8%、67%和75%,两组比较差异无统计学意义,z=-0.24,P=0.800;骨髓抑制Ⅱ/Ⅲ级GRT和GP/GCRT组分别为33%和58%,Ⅳ级分别为5%和17%,两组比较差异有统计学意义,z=-2.387,P=0.017;Ⅰ/Ⅱ级急性放射性肺炎GRT和GP/GCRT组分别为22%和54%,两组比较差异有统计学意义,z=-2.654,P=0.008;Ⅰ/Ⅱ级放射性食管炎GRT和GP/GCRT组分别为67%和92%,两组比较差异有统计学意义,z=-2.175,P=0.030;1和2年生存率GRT组分别为55%和40%,GP/GCRT组分别为60%和38%,两组比较差异无统计学意义,logrank值分别为0.39和0.42,P值分别为0.55和0.48。结论:键择单药同步适形放疗Ⅲ期NSCLC的近期疗效优于健择联合铂类同步适形放疗,前者急性毒性反应的发生率明显低于后者,除部分骨髓抑制Ⅲ/Ⅳ级患者需要阶段性暂停放疗外,多数患者不需要中断治疗,耐受性良好。

OBJECTIVE： To compare the efficacy and tolerability of different uses of gemcitabine combined with 3-dimensional conformal radiotherapy （3DCRT） for stage Ⅲ non-small cell lung cancer （NSCLC）. METHODS： Fifty-five patients with stage Ⅲ NSCLC who received concurrent gemcitabine and 3DCRT were analysed retrospectively to observe the efficacy and treatment-related toxicity, RESULT： In GRT group, the CR, PR and the overall response rate were 7 %, 70% and 77%, respectively. In GP/GCRT group, they were 8%, 67% and 75%, respectively （z=-0.24,P= 0. 800）; Grade 2/3 myelosuppression was seen in 33%, 58% of patients, and Grade 4 could be seen in 5%, 17% of patients in GRT and GP/GCRT group, respectively （z=-2, 387, P=0. 017）. Grade1/2 radiation pneumonitis was seen in 22%, 54% of patients in GRT and GP/GCRT group respectively （z= -2. 654, P= 0, 008）, and Grade 1/2 radiation esophagitis were 67%, 92% respectively （z=-2. 175, P=0. 030）. The 1-, 2-year survival rates were 55%, 40% in GRT and 60%, 38% in GP/GCRT. CONCLUSION： Compared with the combined chemotherapy, the treatment of gemcitabine alone combined with 3DCRT gains higher efficacy but lower toxicity and good tolerability.