NSCLC对小剂量紫杉醇同步放化疗的观察

Clinical observation in advanced non-small cell lung cancer concurrent chemo-radiotherapy with low-dose paclitaxel

目的观察小剂量紫杉醇配合同步放疗对局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法 88例Ⅲ期NSCLC患者随机分为两组:A组(小剂量紫杉醇配合同步放疗)45例,同步放化疗中放疗采用三维适形放疗技术,DT60～66Gy/30～33f/6～7w。化疗使用小剂量紫杉醇方案,紫杉醇45mg/m2qw(放疗期间);B组43例,放疗方式同A组,化疗使用EP方案,依托泊苷50mg/m2d1-5,d29-33;顺铂50mg/m2d1、8、29、36。治疗完成后评价疗效和不良反应。结果 A组总有效率(CR+PR)75.6%;1、2、3年生存率分别为48.9%,31.1%,22.2%;中位生存时间18.8个月。B组总有效率76.7%;1、2、3年生存率分别为51.7%,30.2%,21%,中位生存时间19.2个月。两组间总有效率和生存率均无显著统计学差异(P>0.05)。毒副反应主要是放射性肺炎、放射性食管炎和骨髓抑制,两组间有显著统计学差异(P<0.05)。结论小剂量紫杉醇同步放化疗与EP方案同步放化疗疗效相当,并有降低毒副作用的优点,值得临床推广。

Objective To observe theefficacyand toxicityoflow-dosepaclitaxelcombined concurrentradiotherapyonlocallyadvanced non-small cell lung cancer（NSCLC）.Methods 88 cases of stage Ⅲ NSCLC patients were randomly divided into two groups：45 cases in the group A（low-dose paclitaxel combined with concurrent radiotherapy）,in which used 3 dimensional conformal radiotherapy（3-DCRT）,DT 60Gy ～ 66 Gy/30f ～ 33f/6w ～ 7w.And paclitaxel used 45 mg/m^2 qw（during radiotherapy） in low doses regimen.43 cases in the group B,radiotherapy same as that of the group A,combined with EP regimen,etoposide 50 mg/m^2 d1-5,d29-33;cisplatin 50 mg/m^2 d1,8,29,36.The efficacy and adverse reactions were evaluated after the treatment.Results A total effective rate（CR ＋ PR） was 75.6% ;1,2,3 year survival rates were 48.9%,31.1%,22.2% respectively,the median survival time was 18.8 months in the group A.The total efficiency rate was 76.7%,1,2,3-year survival rates were 51.7%,30.2%,21% respectively,with a median survival time was 19.2 months in the group B.It was no significant statistical difference（P〉 0.05） between the two groups in the total effective rate and the survival rate.Group A had less toxicity than that of group B mainly in radiation pneumonitis,radiation esophagitis and bone marrow suppression,there was significant statistically difference between the two groups（P 〈0.05）.Conclusion The efficacy of low-dose paclitaxel with concurrent radiotherapy is equivalent to that of EP regimen with concurrent chemo-radiotherapy and the former have less toxicity,it is worthy to be popularized.