Ⅲ期非小细胞肺癌同步放化疗与单纯放疗的临床研究

Clinical study of combination chemoradiotherapy and radiotherapy alone in the treatment of inoperable stage ⅢA/ⅢB non-small cell lung cancer

目的:观察同步放化疗与单纯放疗治疗不能手术的ⅢA、ⅢB期非小细胞肺癌(NSCLC)的生存情况。方法:62例ⅢA、ⅢB期NSCLC患者被随机分成同步放化疗组(n=32)和单纯放疗组(n=30)。单纯放疗组为原发灶和区域淋巴结前程超分割照射,每次1.2Gy,每天2次,总量45.6Gy;后程加速超分割照射,每次1.6Gy,每天2次,肿瘤灶总量为68Gy。同步放化疗组在放疗同时给予足叶乙甙50mg/m2,顺铂20mg/m2,第1～3、15～17、29～31天。结果:同步放化疗组中位无疾病进展生存期(PFS)为12个月,显著高于单纯放疗组8个月(P=0.002)。同步放化疗组中位总生存期(OS)为16个月,显著高于单纯放疗组14个月(P=0.011)。同步放化疗组的1年生存率为81.3%(26/32),单纯放疗组的1年生存率为63.3%(19/30),两组无统计学差异(P=0.114)。同步放化疗组的3年生存率为25.5%,显著高于单纯放疗组3.3%(P=0.016)。同步放化疗组的5年生存率为15.6%,显著高于单纯放疗组0(P=0.024)。结论:化、放疗同步治疗与单纯放射治疗相比能显著提高不能手术治疗的ⅢA、ⅢB期NSCLC患者的长期生存率。

Objective：To evaluate the progression free survival（PFS） and overall survival（OS） ＇after concomitant chemoradiotherapy and radiotherapy alone for inoperable stage Ⅲ A/Ⅲ B non-small cell lung cancer（NSCLC） patients. Methods：Sixty-two patients with stage ⅢA/ⅢB NSCLC were randomly divided into concomitant ehemoradiotherapy（ Group I , n = 32） and radiotherapy alone group（Group II, n = 30）. Group II accepted first course hyperfractionation radiotherapy of primary focus and regional lymph node（ 1.2Gy each time, twice a day, and 45.6Gy in total） and late course accelerated hyperfractionation radiotberapy（ 1.6Gy each time, twice a day, and total 68Gy of tumor focus）. Group i was treated with 50mg/m^2 etoposide and 20mg/m^2 cisplatin when accepting radiotherapy for the days 1-3, 15-17, and 29-31. Results：The medium PFS（ 12 months） of patients from the Group I was obviously higher than that（8 months） of Group II （ P = 0. 002）. The medium OS（ 16 months） of patients from the Group I was obviously higher than that（ 14 months） of Group II （ P = 0. 011 ）. The 1-year survival rate of Group I was 81.3% （26/32） , and that of Group II was 63.3 % （19/30） , and the two groups had no statistical difference （ P = 0. 114 ）. The 3-year survival rate （ 25.5 % ） of Group I was obviously higher than that（3.3% ） of Group II （ P =0. 016）. In addition, the 5-year survival rate of Group I was 15.6% , and obviously higher than that（0. 0% ） of Group II （ P = 0. 024）. Conclusion：Combination chemoradiotherapy, compared with radiotherapy alone, could obviously enhance the long-term survival rate of patients in the inoperable stage Ⅲ A/Ⅲ B NSCLC.