NP方案联合三维适形放疗治疗局部晚期非小细胞肺癌疗效分析

Efficacy of concurrent radiochemotherapy with vinorelbine and cisplatin in locally advanced non-small cell lung cancer

目的:探讨长春瑞滨、顺铂同期联合三维适形放疗治疗不能手术的局部晚期非小细胞肺癌的疗效及患者耐受性。方法:对68例经病理或细胞学确诊的不能手术选择的局部晚期非小细胞肺癌患者随机分为A、B两组。A组35例给长春瑞滨联合顺铂方案诱导化疗2周期后,从第3周期第1天开始施行同步放化疗,放疗期间继续原方案化疗2周期。B组33例给长春瑞滨联合顺铂方案第1周期化疗第1天开始实行放疗,放疗期间化疗2周期,同步放化疗结束后即第3周期开始予原方案巩固化疗2周期。两组化疗方案均采用长春瑞滨联合顺铂方案化疗(长春瑞滨25mg/m2,第1、8天;顺铂25mg/m2,第1、2、3天,28天重复)。放疗采用6MV-X射线,前程普通照射,后程三维适形放疗,常规剂量分割,普通外照射DT40Gy后缩野,改用三维适形放疗技术,追加剂量至DT60-66Gy。结果:所有患者均顺利完成治疗。A组有效率48.6%(CR3例,PR18例),1,2年生存率分别为51.4%和34.3%;B组有效率75.8%(CR5例,PR19例),1,2年生存率分别为78.8%和65.6%,两组间差异有显著性。不良反应主要是白细胞减少,恶心、呕吐,放射性食道炎及肺炎。发生率以诱导化疗组高,但差异无显著性,严重不良反应少。结论:长春瑞滨联合顺铂方案同步放化疗治疗不能手术的局部晚期非小细胞肺癌近期疗效较理想,不良反应轻,患者能耐受。同步放化疗后巩固化疗效果较诱导化疗后同步放化疗提高了生存率,两种治疗方法的不良反应无较大区别。

Objective： Effect of concurrent radiochemotherapy with vinorelbine （NVB） and cisplatin （DDP） in locally advanced non -small cell lung cancer（NSCLC） were evaluated. Methods：Sixty eight patients with inoperable stage Ⅲ NSCLC were randomized into 2 groups, all treated with concurrent radiochemotherapy,35 patients in group A received concurrent radiochemotherapy after two cycles of neoadjuvant chemotherapy and 33 patients in group B re- ceived concurrent radiochemotherapy before two cycles of adjuvant chemotherapy. Both groups were given 6MV - X ray for ordinary radiotherapy with a total dose of 40 Gy/20f, then given 6MV - X ray for three - dimensional conformal radiotherapy with a total dose of 20 - 26 Gy/lO - 13f. The two groups were given two cycles of NVB ＋ DDP （ vinorel- bine 25 mg/m2 on the 1st and 8th day,cisplatin 25mg/m2 on the lst,2nd and 3rd day） while radiotherapy. Results： The overall response rate was 48.6% in group A versus 75.8% in group B ,with statistically significant difference （P 〈0.05）. The 1 - and 2 - year survival rates in group A were lower than those in group B （51.4% and 34.3% vs 78.8% and 65.6%, P 〈 0.05 ）. The main toxic reactions were leucopenia, nausea/vomiting, radiation esophagitis and pneumonitis. The total incidence of side reactions in group A was higher than that in group B, but without statisti- cal difference between the two groups. Conclusion： Concurrent radiochemotherapy plus neoadjuvant or adjuvant chem- otherapy with regimen of vinorelbine/cisplatin was effective and safe in the treatment of unresectable stage Ⅲ NSCLC. The efficacy in group A is higher than that of in group B, with statistically significant difference. Toxicity of the two groups is similar.