化疗放射联合与单纯放射治疗不能手术的Ⅲ期非小细胞肺癌

CHEMOTHERAPY COMBINED WITH RADIOTHERAPY VERSUS RADIOTHERAPY ALONE FOR INOPERABLE STAGE Ⅲ NON-SMALL CELL LUNG CANCER

８４例不能手术的Ⅲ期非小细胞肺癌患者被随机分组研究。４１例接受ＣｏＡＰＣ方案（环磷酰胺，长春新碱、阿霉素、顺铂、环已亚硝脲）或ＭＰＶ方案（丝裂霉素、顺铂、长春花碱）化疗。２～４疗程后给予放疗。４３例接受单纯放疗。两组的放疗方式和剂量相同，原发灶和转移肿瘤部位及淋巴引流区常规分次放射５０～６８Ｇｙ。化放组总有效率６３．４％，完全缓解率１４．６％，单放组总有效率５５．８％，完全缓解率７．０％。化放组和单放组中数生存期分别为１４个月和９个月。化疗的毒副作用主要是胃肠道反应和骨髓抑制。放疗毒副反应主要是放射性肺炎和肺纤维化。

AbstractEighty-four patients with locally inoperable and regionally advanced(Stage Ⅲ a,b) non-small cell lung cancer were randomized in this study。 Forty-one patients received combinedchemotherapy with cyclophosphamide(300mg/m￣2,D1),vincristine (2mg, D1 ), adriamycin(50mg/m￣2,D1), lomustine(50mg/m￣2,D1),cisplatin(20 mg/m￣2,D1), or mitomycin(8-10mg/m￣2,D1), cisplatin(20 mg/m￣2,D1─5),vinblastine(10 mg,D6) for 2─4cycles, followed by radia-tion therapy(RT).Fourty─three patients received RT alone。 RT in both group was similar withdoses of 50─68 Gy in conventional fractionation to areas of primary and lymph node involvementand regionally lymphatic drainage areas。 The overall response rate in chemotherapy plus RTgroup was 63.4%, complete response rate was 14.6%,median survival time was 14 months, andone─year survival rate was 63.4%。 The overall response rate in the RT group was 55.8%withacomplete response rate of 7.0%。 The median survival time was 9 months and one─vear survivalrate was 34.9%, The difference of overall response rates was not statistically significant(P>0. 25),but the survival was(P<0. 005) in both groups。 The major toxic effects of chemotherapy were gastrointestinal tract reaction─nausea , vomitting andmyelosuppression─leukopenia andanemia. Toxicity of RT in both groups was similar(pneumonitis and pulmonary fibrosis).