EP方案和PP方案同步放化疗治疗Ⅲ期非小细胞肺癌的比较

Analysis of EP and PP regiments concurrent chemoradiotherapy in the treatment of non-small cell lung cancer

目的:比较EP方案和PP方案同步放化疗治疗Ⅲ期非小细胞肺癌(NSCLC)的近期疗效、生存率和毒副反应。方法:60例不能手术的Ⅲ期NSCLC患者根据入选标准随机分组,其中EP组28例,PP组32例。EP组化疗方案为:顺铂(DDP)20mg/m2,第1-5天;依托泊苷(VP-16)100mg/d,第1-5天。PP组化疗方案为:紫杉醇(PTX)135mg/m2,第1天,顺铂(DDP)70mg/m2,第1天;每21天一周期,共四个周期。同步给予调强放射治疗,放疗均为常规分割,放疗的总剂量为95%PTV DT:(60-66)Gy/(30-33)f。结果:所有患者均顺利完成治疗。EP组CR 7.1%,PR 67.9%,SD 10.7%,PD 14.3%,总有效率为75.0%;PP组CR 12.5%,PR68.8%,SD 12.5%,PD 6.3%,总有效率为81.3%,两组近期疗效差异无统计学意义(P>0.05)。EP组和PP组的1年、2年生存率分别为76.4%、50.9%和78.6%、52.3%。两组1年、2年生存率差异无统计学意义。主要毒副反应为1-3级放射性肺炎、放射性食管炎、消化道反应和白细胞减少,其中PP组发生率比EP组高,但无统计学意义。结论:EP方案和PP方案的同步放化疗比较,PP组近期疗效和1年、2年生存率较好,毒副反应较强。从卫生经济学角度,EP方案值得进一步推广应用。

Objective ：To evaluate the short -term clinical effect and survival rate and toxicities and local control rate of EP regimen and PP regimen in the use of concurrent chemoradiotherapy of non - small cell lung cancer （NSCLC）. Methods： Sixty patients with locally advanced stage NSCLC were randomly divided into two groups, twen- ty - eight patients （ Group EP） were treated with the chemotherapy regimen of VP - 16 （ 100mg/d,d1 - d5 ） and DDP （20mg/d,d1 - d5 ） ,while the other thirty - two patients （ Group PP） were treated with PTX （ 135mg/m：, dl ） and DDP （70mg/m^2, d1 ）. For both groups,the same radiation technique was given with the conventional radiotherapy of IMRT（ intensity modulated radiation therapy）. The radiotherapy was given to the patients ,95% F1N DT： （ 60 - 66） Gy/（30 - 33 ） f. Results： All patients completed the treatment schedule. The overall response rate （ CP ＋ PR） in the PP regiment was higher than the EP：81.3% vs 75.0% （P 〉0. 05） ;In Group EP and Group PP,the 1 and 2 years survival rates were 76.4% ,50.9% , and 78.6%, 52.3% （ P 〉 0.05 ）. There was no significant difference between them. Neither Group EP nor Group PP could avoid the high toxicity rate of radiation esophagitis and pneumonitis and leueopenia and gastrointestinal reaction at grade I - III ,there was no significant difference between them. Conclusion ：The short - term clinical effect and survival rate and local control rate of PP regimen in the use of concurrent ehemoradiotherapy of non - small cell lung cancer （ NSCLC ） were better, but the toxieities were higher. EP sigmen is reasonable and effective therapy.