局部晚期非小细胞肺癌三维适形放疗同步序贯化疗的临床研究

Three dimensional conformal radiotherapy combined with concurrent or sequential chemotherapy for locally advanced non-small cell lung cancer

目的观察分析三维适形放疗同步化疗与序贯化疗治疗局部晚期非小细胞肺癌的疗效及不良反应。方法将53例局部晚期非小细胞肺癌患者随机分为两组:同步组(27例)和序贯组(26例)。同步组采用三维适形放疗(3DCRT)联合吉西他滨和顺铂同步化疗,放疗后再予以吉西他滨及顺铂化疗2个周期;序贯组采用3DCRT结束后,予以吉西他滨和顺铂化疗4个周期。结果同步和序贯两组有效率(PR+CR)分别为70.4%和53.8%,两组比较差异无统计学意义(P>0.05);1年生存率分别为81.5%和61.5%,2年生存率分别为37.0%和26.9%,两组比较差异无统计学意义(P>0.05);中位生存期为17.0个月和13.0个月,两组比较差异有统计学意义(P<0.05)。不良反应以骨髓抑制、放射性食管炎为主,差异无统计学意义(P>0.05)。结论 3DCRT联合吉西他滨同步化疗在近期疗效上优于序贯化疗,在不良反应上无差别。

Objective To observe the toxicity and efficacy of concurrent or sequential gemcitabine combined with three di- mensional conformal radiotherapy （3DCRT） for locally advanced non-small cell lung cancer（NSCLC）. Methods Fifty-three patients with pathologically diagnosed locally advanced III A/II B non-small cell lung cancer were divided into two groups. The concurent chemotherapy and radiotherapy（CCRT） group included 27 cases, treated by 3DCRT combined with gemcitabine and eisplatin concurrent chemotherapy, followed by 2 cycles of consolidation chemotherapy. The sequential chemotherapy and radio- therapy（SCRT） group included 26 cases, received 3DCRT, then gemcitabine and cisplatin chemotherapy for 4 therapy cycles. Results The overall response rate （ CR ＋ PR） were 70.4% and 53.8% in CCRT group and SCRT group, there was no signifi- cant difference between the two groups （P 〉0. 05） , the 1-year survival rate was 81.5% vs. 61.5% and the 2-year survival rate was 37.0% vs. 26. 9% , there were no significant difference between the two groups （ P 〉 0. 05 ）. The median survival time was 17.0 months vs. 13.0 months, there was significant difference between the two groups（P 〈0. 05）. The adverse events included marrow suppression, radiation esophagitis, there was no significant difference between the two groups （P 〉 0.05 ） . Conclusion Concurrent treatment with gemcitabine and radiotherapy for locally advanced non-small cell lung cancer tends to have better results than sequential therapy, and there is no significant difference in adverse reactions between the two kinds of treatment.