同步放化疗联合沙利度胺治疗晚期非小细胞肺癌的临床研究

Clinical study of thalidomide combined with chemotherapy followed by concurrent radiotherapy for the treatment of advanced non-small cell lung cancer

目的研究同步放化疗联合沙利度胺治疗晚期非小细胞肺癌(NSCLC)的临床效果及毒副反应。方法选择在本中心治疗的68例经病理证实的晚期NSCLC患者,随机分为治疗组和对照组。治疗组采用三维立体定向适形放射治疗(3DCRT),经螺旋CT定位后勾画出靶区,给予4～6个非共面适形聚集照射。放疗剂量每次1.8～2.0Gy,每天1次,每周5 d,总剂量64～70 Gy,同步行NP方案+沙利度胺治疗,沙利度胺每天200 mg,口服,第1天起连续给药;长春瑞滨25 mg/m2,静脉滴注,d1,d8;顺铂70 mg/m2,静脉滴注,分d1,d2,每4周重复1次,化疗4～6个周期。对照组采用同步放化疗,具体方法同治疗组。结果68例患者均可评价。治疗组和对照组的中位疾病进展时间(TTP)分别是6.9个月和4.0个月,两组比较,治疗组的中位TTP显著延长,差异有统计学意义(P=0.0024)。治疗组和对照组有效率分别是56.3%(18/32)和41.7%(15/36),治疗组有效率高于对照组。2组不良反应发生率比较差异无显著性(P>0.05)。通过治疗,治疗组患者生活质量评分较对照组有所提高。结论同步放化疗联合沙利度胺治疗晚期非小细胞肺癌具有增敏协同作用,能显著提高患者中位TTP,生活质量得到改善,毒副作用可以耐受。

Objective To study the simultaneous release of thalidomide combined with chemotherapy for the treatment of advanced non-small cell lung cancer（NSCLC）,the clinical efficacy and toxicity.Methods 68 patients with pathologically confirmed advanced NSCLC were randomly divided into treatment group and control group.The treatment group were treated with three-dimensional stereotactic conformal radiotherapy（3DCRT）,by spiral CT-sketched out after the target area,to give 4 to 6 non-coplanar conformal radiation gathering.Radiation dose for each 1.8 ～2.0 Gy,day 1,5 days a week,with a total dose of 64～70Gy,synchronous line NP programs ＋ thalidomide treatment,thalidomide daily 200mg,oral,1st day continuous drug delivery;Vinorelbine 25 mg/m2,infusion,d1,d8;cisplatin 70mg/m2,intravenous,sub-d1,d2,repeated every four weeks,chemotherapy 4 to 6 cycles.The control group were treated with simultaneous radiotherapy and chemotherapy,similar to the treatment group.Results 68 patients were available for evaluation.For the treatment group and control group,the median time to progression（TTP） were 6.9 months and 4.0 months respectively.For the treatment group,the median TTP was significantly prolonged.The difference was statistically significant（P= 0.0024）.The effective rate of the treatment group and control group was respectively 56.3%（18/32） and 41.7%（15/36）.The former was higher than the latter.The incidence of adverse reactions between the two groups showed no significant difference（P0.05）.Through the treatment,the patients life quality score of the treatment group increased.Conclusion Concurrent chemotherapy combined thalidomide treatment for advanced non-small cell lung cancer has the sensitizing effect,which can significantly improve patients＇ median TTP.The quality of life can be improved,and toxic side effects can be tolerated.