GP方案同步放疗治疗Ⅲ期非小细胞肺癌的临床研究

Clinical Study of Concomitant Radiotherapy Using Gecitabine Plus Cisplatin for Stage Ⅲ Non-Small Cell Lung Cancer

目的观察和评价吉西他滨联合顺铂(GP)同步放疗治疗Ⅲ期非小细胞肺癌的耐受性和近期疗效。方法42例Ⅲ期非小细胞肺癌患者随机分为2组,放疗组21例先采取常规前后野对穿照射,剂量40Gy后改为调强适形放射治疗,包括原发灶和转移淋巴结,25～30Gy/10～12次,总剂量为65～70Gy。同步放化疗组的放射治疗同单纯放疗组,化疗采用吉西他滨1g/m2第1、8天静脉滴注,顺铂30mg/m2·d,第1～3天静脉滴注,21d为1个化疗周期,化疗共4～6个周期。结果同步放化疗组与单纯放疗组总有效率分别为85.7%和57.1%,两组差异有统计学意义。同步放化疗组1、2、3年生存率为66.7%、33.3%、23.8%,单纯放疗组1、2、3年生存率为38.1%、14.3%、9.5%,两组差异有统计学意义(P<0.05)。两组的不良反应除骨髓抑制和消化道反应外无显著性差异。结论GP方案同步放疗治疗Ⅲ期非小细胞肺癌患者耐受性良好,疗效满意,远期疗效有待进一步观察。

Objective To evaluate the clinical efficacy and tolerance of Gecitabine plus cisplatin （GP） concomitant radiotherapy in patients with stage Ⅲ non-small cell lung cancer. Method From January 2002 to January 2004, 42 patients with stage Ⅲ non-small cell lung cancer were randomly and equally divided into two groups： radiotherapy group and concomitant chemoradiotherapy group. Patients in the radiotherapy group were initially treated with a conventional dose of 40 Gy, then followed by modulated radiotherapy （MRT） at 25-30 Gy/10-12 times with the total dose of 65-70 Gy. Patients in the chemoradiotherapy group were treated with 4 to 6 cycles of concomitant radiotherapy and chemotherapy. Each cycle （21 days） of the treatment consisted of an intravenous injection of Gecitabine （1g/m^2 at dl and d8） and cisplatin （30 mg/m^2 from dl to d3）. Result The overall response rate （CR＋ PR） in concomitant chemoradiotherapy group and radiotherapy group was 85.7% and 57.1%, respectively （P〈0.05）. The 1, 2 and 3-year survival rate was 66.7%, 33.3% and 23.8% for the concomitant chemoradiotherapy group and 38.1%, 14.3% and 9.5% for the radiotherapy group, respectively （P〈0.05）. With the exception of myelosuppression and digestive reaction, the difference in the toxicity was not significant （P〉0.05）. Conclusion Concomitant radiotherapy with Gecitabine plus cisplatin can significantly improve the response rate in patients with stage Ⅲ nonsmall cell lung cancer and the toxicity is well tolerated. However, monitoring of the long-term survival is required.