局部晚期非小细胞肺癌同步放化疗联合巩固化疗或诱导化疗的随机临床研究

A Randomized Clinical Study:Concurrent Chemoradiotherapy Combined with Consolidation or Induction Chemotherapy for Locally Advanced Non-small Cell lung Cancer.

目的评价同步放化疗联合联合巩固化疗或诱导化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效及毒不良反应,并比较两者差异性。方法64例ⅢA和ⅢB期的NSCLC患者随机分为两组,CCT组第1周期TP(多西他赛和顺铂)化疗第1天就开始实施放疗,同步放化疗结束后按计划从第43天开始TP巩固2周期化疗;ICT组第1天用TP诱导化疗2周期,从第3周期第1天(第43天)开始实行放化疗同步。化疗均为4个周期的TP方案,21天为1周期。采用三维适形放疗,胸部照射2Gy/次,5次/周,共6～7周,总剂量54～66Gy,中位剂量为60Gy。结果CCT和ICT组的有效率分别为60.0%和58.8%(P=0.924)。主要毒性为血液学毒性、放射性肺损伤和放射性食管炎,但两组并未出现明显差异。结论局部晚期NSCLC同步放化疗前后诱导与巩固化疗的近期疗效相近,时序对不良反应的发生率没有影响。同步放化疗治疗Ⅲ期NSCLC有较好的疗效,不良反应可以耐受。

Objective To investigate the efficacy and the side - effects of concurrent chemoradiotherapy combined with consolidation or induction chemotherapy for locally advanced non - small cell lung cancer （NSCLC）. Methods 64 patients with stage Ⅲ A and Ⅲ B NSCLC were divided randomly into the CCT group （concurrent ehemoradiotherapy followed by consolidation chemotherapy） and the ICT group （ induction chemotherapy followed by concurrent chemoradiotherapy）. All patients were deliverd to thoracic planning target with total dose of 54 -66Gy （median close 60Gy）in 6 - 7 weeks. CCT group started to irradiate by eonformal radiotherapy technique on clay 1 , and ICT started on day 43 with single fraction dose 200 cGy and 5 fractions every week. Results The response rate in CCT and ICT group was 60.0% and 58.8% respectively （ P = 0. 924） , with no statistic significance between the CCT and ICT group. The side - effects were mainly granu]o -cytopernia, radiation espohagitis and radiation pneumonitis. Conclusion Concurrent chemoradiotherapy combined with consolidation or induction chemotherapy for locally advanced NSCLC is well tolerated. The sequence of adjuvant chemothreapy to concurrent chemoradiotherapy produced no significant difference for NSCLC in recent response.