超分割放疗同步化疗治疗Ⅲ期非小细胞肺癌

Hyperfractionation radiotherapy combined with chemotherapy for stage-Ⅲ non-small cell lung cancer

目的观察超分割放疗结合不同时机化疗治疗Ⅲ期非小细胞肺癌的临床疗效。方法选择Ⅲ期非小细胞肺癌患者112例，随机分为放化疗同步治疗组56例（A组）和放疗后化疗的序贯治疗组56例（B组），两组病例均给以超分割放疗（1．2Gy／次，2次／d，10次／周，总DT69．6Gy）。同步组（A组）放疗开始的1，5，10，15周给予化疗（顺铂20mg／m^2，第1—5天；足叶乙甙50mg/m^2，第1—5天），化疗4个周期，每4周为1个周期；序贯组（B组）在放射治疗结束后给予4个周期化疗（顺铂100mg/m^2，第1天；足叶乙甙100mg／m^2，第1—3天），每4周为1个周期。结果同步组和序贯组近期有效率分别为75．0％和57．1％（X^2=2．32，P〈0．05）；1，3，4年生存率、中位生存期分别为73．2％、28．6％、10．7％、28个月和66．1％、12．5％、3．6％、19个月，两组中位生存期差异有显著性（t=2．32，P〈0．05），两组患者的生存率差异无显著性。两组患者的毒副反应主要为可逆性骨髓抑制、放射性食管炎和放射性肺炎，两组发生率相似。结论同步化疗结合超分割放射治疗非小细胞肺癌效果优于超分割放疗后化疗的序贯治疗。

Objective To investigate the efficacy of hyperfractionation radiotherapy combined with chemotherapy in treatment of stage-Ⅲ non-small cell lung cancer. Methods 112 patients with advanced non-small cell lung cancer were randomized into two groups：concurrent radiochemotherapy group included 56 patients（ group A） and sequential radiochemotherapy group included 56 patients （group B）. All patients in the two groups were treated with hyperfractionation radiotherapy （ 1.2 Gy per fraction and two fractions per day with 6-hour interval, 10 fractions per week with the total dose of 69.6 Gy）. Patients in group A received concurrent radiotherapy and chemotherapy DDP （ 20 mg/m^2, d1-d5 ） and Vp-16 （ 50 mg/m^2, d1-d5 ） in the first,fifth,tenth and fifteenth weeks. Patients in group B received four cycles of sequential radiotherapy and chemotherapy DDP （ 100 mg/m^2, dl ） and Vp-16 （ 100 mg/m^2, d1-d3 ）. Results The response rate was 75.0% in group A and 57.1% in group B （ X^2 = 6.4, P 〈 0.05 ）. The 1-,3-,4- year survival time rates and median survival time were 73.2% ,28.6% ,10.7% and 28 months in group A,and 66.1% ,12.5% ,3.6% and 19 months in group B respectively, with significant difference in median survival time （ t = 2. 32, P 〈 0.05） and no significant difference in survival rate. The toxicity in two groups had no significant difference. Conclusion Efficacy of hyperfractionation radiotherapy with concurrent chemotherapy is higher than that of sequential radiochemotherapy for non-small cell lung cancer.