比较培美曲塞和紫杉醇同期化放疗治疗局部晚期老年肺腺癌临床观察

Clinical observation of pemetrexed or palitaxel combined with concurrent radiotherapy in elderly patients with locally advanced lung adenocarcinoma

目的:比较培美曲塞和紫杉醇同期化放疗治疗局部晚期老年肺腺癌的近期疗效和急性毒副反应。方法:经组织学确诊符合入组条件的ⅢA或ⅢB老年肺腺癌患者,随机分为试验组和对照组,每组23例。试验组采用培美曲塞(500mg/m2,d1)3～4周为1个周期,共2个周期;对照组采用紫杉醇(50mg/m2)每周1次,共6～7个周期,联合同步放疗。放疗方法为三维适形放疗(3D-CRT),处方剂量为60～70Gy,6～7周完成。评估两组的近期疗效及不良反应。结果:试验组和对照组有效率CR+PR分别为78.3%和65.2%,P>0.05;试验组中性粒细胞减少、血小板减少、血红蛋白下降、恶心呕吐、放射性食管炎、放射性肺炎发生率(Ⅰ～Ⅳ度)分别为60.8%、39.1%、34.7%、65.2%、30.4%和34.7%。对照组分别为82.6%、52.1%、39.1%、60.8%、34.7%和30.4%。其中,Ⅰ～Ⅱ度和Ⅲ～Ⅳ度中性粒细胞减少差异有统计学意义,P<0.05。结论:培美曲塞联合同期放疗较紫杉醇治疗局部晚期老年肺腺癌的近期疗效更好和急性毒副反应更轻,能为大多数老年患者耐受。

OBJECTIVE.. To evaluate the therapeutic efficacy and toxicity in elderly patients with locally advanced lung adenocarcinoma treated with pemetrexed or palitaxel with concurrent radiotherapy. METHODS： Forty-six NSCLC patients diagnosed by histology were randomized into two groups., the trial group （n= 23） pemetrexed（500 mg/m^2 , d1 , repeated after 3-4 weeks） and the control group （n=23） palitaxel（50 mg/m^2 , once a week）. Treatment responses were evaluated after 2 cycles,all patients were treated with concurrent radiotherapy. The primary tumors and involved lymph nodes were administrated three-dimensional conformal radiotherapy （3D-CRT） at a total dose of 60 to 70 Gy （2 Gy/fraction, completed in 6 to 7 weeks）. RESULTS.. The overall response rate（CR-PR） was 78.3% in trial group and 65.2% in control group（P〉0.05）. The incidence Ⅰ-Ⅳ degree of neutropenia,thrombocytopenla, hemoglobin decrease, nausea and vomiting,acute radiation-esophagitis, acute radiation-pneumonia were 60.8%, 39.1%, 34.7o/00, 65.2%, 30.4% and 34.7% in trial group, 82.6% ,52.1%% ,39.1%% ,60.8% ,34.7% and 30.4%, respectively in control group. Rates of Ⅰ-Ⅱ,Ⅲ- Ⅳ grade neutropenia difference were happened between two groups （P〈0.05）. CONCLUSIONS： The concurrent chemoradiotherapy （based on 3D-CRT） of pemetrexed is more effective for elderly patients with locally advanced lung adenocarcinoma than palitaxel. Pemetrexed alsoshows superiority to palitaxel regards to some side effects.