多西他赛加顺铂诱导化疗联合同期放化疗局部晚期非小细胞肺癌的临床观察

Outcomes of docetaxel and cisplatin induction chemotherapy followed by concurrent chemoradiotherapy in locally advanced non-smaU cell lung cancer

目的评价TP方案诱导化疗联合同期放化疗局部晚期非小细胞肺癌的近期疗效和不良反应。方法病理证实的局部晚期非小细胞肺癌86例，随机分成同期放化疗联合TP方案诱导化疗（ICCRT）组和单纯同期放化疗（CCRT）组。放疗均采用调强放疗。治疗结束后比较两组疗效、生存率和不良反应。结果86例患者的随访率为100％。ICCRT组和CCRT组的有效率分别为80％和70％（X^2=1．26，P=0．261），1、2、3年总生存率分别为85％和65％、50％和40％、44％和33％（X^2=3．90，P=0．048），主要不良反应白细胞减少（43例和32例，X^2=3．48，P=0．062）、放射性食管炎（26例和20例，）（X^2=0．12，P=0．730）、血红蛋白减低（26例和16例，X^2=2．34，P=0．126）和放射性肺炎（13例和9例，X^2=0．37，P=0．541）。结论ICCRT能明显提高局部晚期非小细胞肺癌的总生存率，且与CCRT相比并不增加局部不良反应。

Objective To investigate the efficacy and side-effect of docetaxel and cisplatin induction chemotherapy followed by concurrent chemoradiotherapy in locally advanced non-small cell lung cancer （NSCLC）. Methods Eighty-six patients with histologically confirmed locally advanced NSCLC were randomized into induction chemotherapy followed by concurrent chemoradiotherapy （ICCRT） arm or concurrent chemoradiotherapy （CCRT） arm. Both arms were treated with intensity-modulated radiation therapy . Induction and concurrent chemotherapy regimen consist of docetaxel and cisplatin . Results FoUow-up rate of the whole group is 100%. The response rate in the CCRT arm and ICCRT arm is 70% and 80% （X^2 = 1. 26,P =0. 261 ） , respectively;and 1-, 2-, 3-year survival rate is 65% and 85%, 40% and 50% , 33% and 44% （ X^2 = 3.90, P = 0. 048 ）, respectively; the median survival time and time to progression is 17.5 and 22.0 months and 14.0 and 19.0 months respectively. Major adverse effects are leukopenia （43 and 32 cases,X^2 = 3.48, P = 0. 062）, radiation esophagutis （26 and 20 cases,X^2 = 0. 12, P =0. 730）, anemia （26 and 16 cases, X2 =2.34,P =0. 126） and radiation pneumonitis （ 13 and 9 cases,X^2 = O. 37, P =0. 541）. Conclusions ICCPtT for locaily advanced NSCLC can improve the overall survival rate and time to progression, induction chemotherapy did not increase side-effects. There was no difference in response rate between CCRT and ICCRT arm.