吉西他滨联合顺铂双途径用药治疗晚期非小细胞肺癌临床对照研究

Gemcitabine and cisplatin combination chemotherapy with double way in advanced non small cell lung cancer

目的对比观察吉西他滨联合顺铂双途径用药与同方案全身化疗治疗晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法纳入晚期NSCLC患者60例随机分为2组。介入组(n=30):吉西他滨1000 mg/m^2,顺铂100 mg/m^2,第1天吉西他滨+顺铂总量的1/3采用Seldinger法插管行支气管动脉灌注化疗,顺铂余量于第2～3天静脉滴注。第8天吉西他滨单药静脉滴注用药,21 d为1个周期。全身化疗组(n=30):吉西他滨1000 mg/m^2静脉滴注,第1、8天;顺铂总量100 mg/m^2,分3次在第1～3天静脉滴注,21d为1个周期。2组病例均至少完成2个周期后进行评价。结果介入组有效率(56.7%)高于化疗组(40.0%),但差异无统计学意义(P>0.05),临床获益率(86.7%)和1年生存率(46.7%)亦高于化疗组(分别为63.3%和20.0%),且差异均有统计学意义(P<0.05)。介入组患者Ⅲ～Ⅳ度血小板减少和Ⅰ～Ⅱ度胃肠道反应低于全身化疗组,差异有统计学意义(P均<0.05)。结论吉西他滨联合顺铂双途径用药治疗晚期非小细胞肺癌具有较好的临床疗效,不良反应较轻。

Objective To observe the clinical efficacy and side effects of double way chemotherapy with gemcitabine and cisplatin or medical chemotherapy with the same medicine in treatment advanced non small cell lung cancer （NSCLC）. Methods Consecutive 60 cases with NSCLC were divided into 2 groups randomly. In interventional treatment group （30 cases） , the gemcitabine 1000 mg/m^2 and cisplatin 100 mg/m^2 ,transcatheter bronchial arterial infusion chemotherapy on 1 st day, and the same dose of gemcitablne was infused on 8th day, repeated every 21 days as one cycle. Another group with gemcitabine 1000 mg/m^2 on 1st and 8th days, and 1/3 of cisplatin 100 mg/m^2 was infused 1 - 3 days. All patients received at least 2 cycles. Results in interventional therapy group, the effective rale was 56.7% and clinical beneficial rate was 86.7% ,the 1 year survival rate was 46.7%. In medical chemotherapy group,the effective rate was 40.0% and clinical beneficial rate was 63.3% , the 1 year survival rate was 20.0%. There was significant difference between two groups in clinical beneficial rate and in 1 year survival rate （ P 〈 0.05 ）. The incidence of side effects, including bone marrow depression, and gastrointestinal reaction, were significant lower in intcrvenlional treatment group than medical chemotherapy group （ P 〈 0.05）. Conclusion The combination of gemcitahine and cisplatin with double way on advanced non small cell lung cancer was effective and well tolerated, and fairly adverse reaction.