吉西他滨增敏同期放疗局部晚期非小细胞肺癌的临床观察

Clinical study of gemcitabine with a sensitizer of concurrent radiotherapy in locally advanced non-small cell lung cancer

目的:评价吉西他滨作为放疗增敏剂联合同期放疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效和急性毒副反应。方法:同期放化组:42例采用吉西他滨化疗增敏同期联合放疗治疗不能手术切除的局部晚期(Ⅲ期)NSCLC患者,放疗同期第1、8、15、22、29、36天在放疗前4h给予400mg/m2吉西他滨化疗,放射治疗采用6/15MVX线,每次2Gy/d,5次/周,原发灶50Gy后缩野加量,DT60～70Gy;有锁骨上淋巴结转移者,给予X线和电子线混合照射至DT60～66Gy。单纯放疗组:40例放射治疗方法与同期放化组相同。结果:同期放化组与单纯放疗组肺原发灶有效率分别为90.5%(38/42)和70.0%(28/40),P=0.039;纵隔淋巴结转移灶有效率分别为90.5%(38/42)和82.5%(33/40),P>0.05;中位生存期分别为12.6和10.3个月,两组急性毒副反应主要为骨髓抑制、胃肠道反应、放射性食管炎、放射性肺炎和肝功能受损等,经处理后均可耐受。结论:吉西他滨化疗同期联合放疗局部晚期NSCLC与单纯放疗的比较,近期疗效有提高,急性毒副反应增加不明显,可耐受,吉西他滨有放疗增敏作用。

OBJECTIVE： To evaluate the feasibility and safety of combination gemcitabine chemotherapy with a sensitizer and concurrent radio chemotherapy in stage Ⅲ NSCLC. METHODS： Forty-two patients with inoperable stage Ⅲ NSCLC were treated with gemcitabine and radiotherapy. Chemotherapy consisted of intravenously gemcitabine ,100 mg/m^2 on days 1, 8, 15, 22, 29, 36. Radiotherapy was delivered up to a total dose 60-70 Gy with a 2.0 Gy dose frac tion per day, 5 days per week. Forty patients underwent radiotherapy. RESULTS： The overall response rates of primary tumor and mediastinum metastatic node were 90. 5% （38/ 42）, 70.0%（28/40）, P=0. 039 and 90.5% （38/42） ,82.5% （33/40）, P〉 0.05, the median survival time was 12.6 months, 10.3 months （P=0.035）, respectively. The acute side effects of patients were mostly myelosuppression, nausea. vomiting, radiation-induced esophagitis and pneumonitis and liver toxicity. However,all of them were tolerant. CONCLUSIONS： Combined chemo-radiotherapy results in better response and survival as compared to conventional radiotherapy in the treatment of locally advanced nonsmall cell lung cancer without aggravating the side effects. Gemcitabine should be used as a radiosensitizer.