不能手术的Ⅲ期非小细胞肺癌的综合治疗

Combined chemo-radiotherapy for inresectable non-small cell lung cancers

目的 对比研究Ⅲ期非小细胞肺癌放射治疗 +化疗综合治疗的疗效 ,探讨更有效的治疗方式。方法 6 0例Ⅲ期非小细胞肺癌患者均分至 2个组。单放组采用常规分割 ,总量 6 0～ 70Gy ,6～ 7周 ,综合治疗组采用放射治疗加化疗 ,化疗采用以顺铂为主的化疗方案 ,在放射治疗同时或前中后进行 ,最少 2个周期。结果 2个组治疗后完全缓解率 :单放组为 2 0 % ,综合组为 43% ;病情进展率 :单放组为 10 % ,综合组为 7% ,2个组近期疗效差异无显著性意义 (χ2 =4.11,P =0 .2 5 )。 1、2、3年生存率单放组分别为 42 .4%、15 .7%、7.8% ,综合组分别为 6 8.1%、37.8%、18.9% ;中位生存期单放组为 8个月 ,综合组为 15个月。 2个组生存率差异有显著性意义 (χ2 值分别为 4.2 4、4.15、3.96 ,P值均 <0 .0 5 )。综合组副作用大于单放组 (t=4.318,P <0 .0 1)。结论 放射治疗 +化疗综合治疗明显提高Ⅲ期非小细胞肺癌的 1、2、3年生存率 ,更有效的放射治疗 +化疗结合方式为放射治疗

Objective To evaluate the effect of radiotherapy(RT)combined with chemotherapy(C) for stage Ⅲ non small cell lung carcinoma (NSCLC) and to find a more effective way of giving them.Methods From Jan. 1995 to Dec. 1997 , 60 patients with stage Ⅲ NSCLC were randomized into two groups . RT alone group(30 cases) was given conventional fractionated D T 60～70?Gy/6～7 W. The combined group(30 cases) received conventional fractionated radiotherapy plus chemotherapy (DDP,5 FU,VP 16 and IFO, given simulatneosly). In some patients,chemotherapy was also siven before,during and after RT for at least 2 courses. Results CR rates of RT and combined groups were 20% and 43%, respectively . PD rate of the two groups were 10%and 7% . The 1 ,2 and 3 year survival rates were 42.4%,15.7%,7.8% in the RT group and 68.1%,37.8%,18.9% in the combined group(P<0.05). The median survival periods were 8 months and 15 months though the combined group had more obvious side effects than the RT group. Conclusions Combined therapy is able to improve obviously the survival rate of stage Ⅲ NSCLC with the induction therapy very important. We expect a more effective combination is to have RT and C simultaneosly or alternately given.