序贯化放疗与同步化放疗治疗Ⅲ期非小细胞肺癌疗效观察

Sequential Chemoradiotherapy and Concurrent Chemoradiotherapy for Stage m Non-Small-Cell Lung Cancer

目的观察序贯化放疗与同步化放疗治疗Ⅲ期非小细胞肺癌患者的疗效。方法80例Ⅲ期非小细胞肺癌患者随机分为序贯组36例和同步组44例，序贯组采用EP方案化疗4个周期后休息2周开始放射治疗；同步组采用EP方案化疗4个周期，并于第1周期化疗第1天开始放疗。两组放射治疗均采用6MVX直线加速器常规分割治疗．放射治疗总量DT60-70Gy，6-7周完成。结果同步组CR8例，PR30例，有效率（CR＋PR）864％；序贯组CR5例，PR16例，有效率（CR＋PR）58．3％，两组有效率差异有显著性（P〈0．05）。序贯组1、2、3年生存率分别为389％、25．0％、13．9％，同步组1、2、3年生存率分别为65．9％、45．5％、29．5％。中位生存期序贯组和同步组分别为12．5个月和18．5个月。2组间中位生存期及1、2、3年生存率差异有显著性（p〈0．05）。同步组的恶心、呕吐发生率及放射性食管炎的发生率高于序贯组，差异有显著性（P〈0．05），同步组白细胞下降及放射性肺炎的发生率亦较序贯组为高．但差异无显著性（P〉0．05）。结论同步放化疗较序贯放化疗提高了Ⅲ期非小细胞肺癌患者生存率和中位生存期，但同时也增加了严重放射性食管炎的发生风险。

Objective To evaluate the effects of sequential chemoradiotherapy and concurrent ehemoradiotherapy for stage m non-small-cell lung cancer. Methods From January 2002 to June 2006,80 patients with stage m NSCLC were randomized into two groups：SCRT group （36 patients） received sequential chemotherapy with DDP （30mg/m2,d1-d3） and Vp-16 （100 rag/m^2, dl-d3） per cycle,one cycle per 3 weeks was given.Radiation was given after 4 cyeles.CCRT group （44 patients） received radiotherapy plus concurrent chemotherapy with DDP （25mg/m^2,d1-d3） and Vp-16（100 mg/m^2, dl-d3） per cycle for 4 cycles.In both groups,radiation was given to a total dose of 60-70Gy/6-7 weeks. Results The overall response rate（CR＋ PR） in CCRT group was 86.4% with a complete response （CR） rate of 18.2%. The overall response rate in SCRT group was 58.3% with a CR rate of 13.9%. The median survival periods were 12.5 months in SCRT group and 18.5 months in CCRT group （P〈0.05）.The 1-,2- and 3-year survival rates were65.9%, 45.5%, 29.5% , and 38.9%, 25.0%, 13.9% in CCRT and SCRT groups,and the difference in the survival rates was significant （P 〈0.05）. Conclusions The median survival period can be significantly prolonged and also the survival rate improved with concurrent chemoradiotherapy in the treatment of Stage m non-small cell lung cancer.