适形调强放疗联合培美曲赛及顺铂同步和巩固化疗治疗Ⅲ期肺腺癌临床研究

Clinical research of pemetrexed/cisplatin concurrent and consolidate chemotherapy cambined with conformal or intensity-modulated radiotherapy for patients with unresectable stage Ⅲ lung adenocarcinoma

目的评价三维适形或调强放疗联合培美曲赛加顺铂（PC方案）同期和巩固化疗治疗无法手术的Ⅲ期肺腺癌50例疗效和毒副反应，探讨该治疗模式的疗效和安全性。方法回顾性分析50例无法手术的Ⅲ期肺腺癌患者，分别采用三维适形或调强放疗联合培美曲赛＋顺铂同步放化疗及巩固化疗（P组）或依托泊苷十顺铂（EP方案）同步放疗及巩固化疗（E组）。放疗靶区仅包括影像学或临床诊断的肿瘤（GTV），放疗剂量62—74Gy／31—37次。P组方案：培美曲赛500mg／m2、顺铂75mg／Ill。静脉滴注，d1，21天重复；E组方案：顺铂20mg／m2，dl-5，依托泊苷100mg／d，dl-3，静脉滴注，28天重复。放疗期间化疗2～3个周期，放疗结束后按同样方案巩固化疗2—4周期。结果所有患者均完成治疗计划。P组总有效率（CR＋PR）80．0％；E组总有效率（CR＋PR）68．0％。两组均无治疗相关死亡病例。P组和E组中位疾病无进展时间分别为9．2和6．8月（P=0．032）。P组和E组1、2、3年生存率分别为80．0％VS84．0％、48．0％w32．0％（P=0．044）、24．0％傩16．0％。结论适形调强放疗联合PC方案对比EP方案同期和巩固化疗治疗无法手术Ⅲ期肺腺癌，可延长患者PFS和2年生存率。

Objective To evaluate the efiqcacy and safety of pemetrexed and eisplatin concurrent and consolidate chemotherapy combined with thoracic 3D conformal radiation therapy （3DRT） or intensity-modulated radiotherapy （IMRT） in patients with unresectable stage Ⅲ adenoearcinoma of non-small cell lung cancer （NSCLC）. Methods From January t9 October in 2007 % fifty patients with unresectable stage Ⅲ adenoearcinoma were enrolled in this retrospective study. The patients received either radiotherapy combined with pemetrexed plus cisplatin （P arm） or etoposide plus eisplatin （E arm） concurrent and consolidate chemotherapy. 3DRT or IMRT was adopted for the radiotherapy. 3DRT or IMRT plans were designed to deliver 62～ 74 Gy/31 -37 fraction to involved-field that included only the primary tumor and clinically enlarged lymph nodes. P arm （ n = 25 ） received pemetrexed 500 mg/m2 （ dl ） plus cisplatin 75 mg/m2（ dl ）, every 21 days. E arm （ n = 25 ） received etoposide 100 mg/d （ dl - 3 ） plus cisplatin 20 mg/m2 （ dl - 5 ）, every 28 days. Both regimens were administered, concurrent chemotherapy for 2 to 3 cycles and consolidate chemotherapy for 2 to 4 cycles. Results All patients completed the therapy plan. The overall response rate （ CR ＋ PR） in the P arm was 80.0% , and that in the E arm was 68.0%. The median progression-free survival （PFS） in the P arm and E ann were 9.2 months and 6.8 months （HR O. 74,95% CI 0. 62-0.86 ; P = 0. 032 ）. The 1-, 2-, and 3-year survival rates in P arm were 80.0%, 48.0%, 24.0%, respectively, while those in E arm were 84.0% ,32.0% , 16.0% , respectively. The difference in the survival rate was significant in 2-year survival rate （P = 0. 044）. Conclusion For patients with unreseetable stage Ⅲ adenocareinoma of NSCLC, 3DRT or IMRT combined with pemetrexed and cisplatin concurrent and consolidate chemotherapy could improve PFS and increase 2-year survival rate compared with etoposide olus cisplatin.