诱导化疗加放疗与单纯放疗不能手术的Ⅲ期非小细胞肺癌

Induction chemotherapy plus radiation versus radiation alone for inoperable stage Ⅲ nonsmall cell lung cancer

目的评价诱导化疗加放射治疗不能手术的Ⅲ期非小细胞肺癌（ＮｏｎＳｍａｌＣｅｌＬｕｎｇＣａｎ－ｃｅｒ，ＮＳＣＬＣ）疗效。材料与方法１１１例不能手术的Ⅲ期ＮＳＣＬＣ病人被随机分为两组：５５例病人接受丝裂霉素８～１０ｍｇ／ｍ２，第１天；顺铂２０ｍｇ／ｍ２，第１～５天；长春花碱６ｍｇ／ｍ２，第６天（或长春酰胺３ｍｇ／ｍ２第１，８天）联合化疗（ＭＰＶ方案）；２～４疗程后给予放疗（化放组）。５６例病人接受单纯放疗（单放组）。两组放疗方式和剂量相同，常规分割放射，每次２Ｇｙ，每周５次。原发灶和淋巴结受累部位的总剂量为６０～６８Ｇｙ，淋巴引流区５０Ｇｙ。结果化放组总有效率为６３．６％，完全缓解（ＣＲ）１４．５％，中位生存期为１４个月；单放组总有效率为５５．４％，ＣＲ５．４％，中位生存期为１０个月。两组的总有效率无差别（Ｐ＞０．２５），但生存期有明显的差异（Ｐ＜０．０２５）。化疗的毒副反应主要是胃肠道反应和骨髓抑制。两组放疗副反应（急性和迟发性肺损伤）相似。结论诱导化疗加放射治疗不能手术的Ⅲ期ＮＳＣＬＣ，毒性可耐受，生存期优于单纯放疗。

Purpose To evaluate the effect of induction chemotherapy plus radiation for inoperable stage Ⅲ nonsmall cell lung cancer(NSCLC).Materials and Methods 111 patients with inoperable stage Ⅲ NSCLC were randomly divided into two groups:55 patients received combined chemotherapy (CT) with mitomycin C (8～10mg/m2,d1),Cisplatin(20mg/m2,d1～5) and Vinblastine (6mg/m2,d6) or Vindesine (3mg/m2,d1,8) for 2～4 cycles followed by radiotherapy(RT) (CTRT group).56 patients received RT alone(RT group). RT in both groups was similar,patients in conventional fractionation received 2 Gy/per fraction, five fractions/per week,with the total dose of 60～68Gy to areas of primary and lymph node involvement and 50Gy in regionally lymphatic drainage.Results The overall response rate in CTRT group was 63.6%,with the complete response rate of 14.5%,and median survival time 14 months. The overall response rate in the RT group was 55.4%,and the complete response rate was 5.4%.The difference of overall response rates was not statistically significant(P<0.25) in both groups.The major toxic effects of CT were gastrointerstinal tract reactionnausea,vomiting and myelosuppressionleukopenia and anemia.Toxicity of RT in both groups(acute and late lung injury) was similar.Conclusion The result shows that induction chemotherapy plus radiation for inoperable stage Ⅲ NSCLC is acceptable and the survival time is superior to radiotherapy alone.