局部晚期非小细胞肺癌同步放化疗前诱导化疗的临床研究

Clinical research of induction chemotherapy before concurrent chemoradiotherapy in local advanced non-small-cell lung cancer

目的:探讨局部晚期非小细胞肺癌同步放化疗与化疗的配合模式。方法:把符合入组标准的94例局部晚期非小细胞肺癌分为A、B、C三组,A组为直接同步放化疗组,放化疗后行辅助化疗4-6个周期;B组为同步放化疗前行诱导化疗2个周期,放化疗后行辅助化疗2-4个周期;C组为同步放化疗前行诱导化疗4个周期,放化疗后行辅助化疗0-2个周期。比较各组的疗效与毒副反应。结果:随访率95.7%,A、B、C组的有效率(ORR=CR+PR)分别为67.7%、83.3%、66.7%,B组的有效率略高,无显著性差异(P=0.56)。A、B、C三组患者的1、2年生存率分别为70.3%、71.4%、78.5%和37.6%、36.9%、38.8%,中位生存期分别为18.9个月、17.9个月和20.5个月(P=0.763)。治疗毒性方面,3组患者恶心呕吐反应程度相似,A组患者中发生2级以上放射性食管炎比例(32.3%)少于B、C组(分别为50.0%、51.5%),A组患者发生3、4级骨髓抑制比例(29.0%)少于B、C组(46.7%、51.5%),A组患者发生2级以上放射性肺炎比例(67.7%)多于B、C组(53.3%、48.5%)。结论:局部晚期非小细胞肺癌同步放化疗与化疗的配合尚难以确定其固定模式,诱导化疗的选择与应用需进一步研究。

Objective： To explore the pattern of chemotherapy combined with concurrent chemoradiotherapy（ CRT） for locally advanced non- small cell lung cancer（ LANSCLC）. Methods： Ninety- four patients with LANSCLC between May 2011 and May 2013 were reviewed and analysed. All patients met eligibility criteria and were divided into A,B,C groups. Group A received concurrent（ CRT） at the start,and then 4- 6 cycles of adjuvant chemotherapy. Group B underwent 2 cycles of induction chemotherapy before CRT,and 2- 4 cycles of adjuvant chemotherapy after CRT. Group C experienced 4 cycles of induction chemotherapy before CRT and 0- 2 cycles of adjuvant chemotherapy after CRT. Results： The rate of follow- up was 95. 7%. Objective responses（ ORR = CR ＋ PR） in A,B,C groups were 67. 7%,83. 3%,66. 7%,respectively. There was no significant difference（ P = 0. 56） about ORR. The 1- year and 2- year survival of A,B,C groups were 70. 3%,71. 4%,78. 5% and 37. 6%,36. 9%,38. 8%,respectively. The median survival time（ MST） was 18. 9 months,17. 9 months and 20. 5 months（ P = 0. 763） for A,B,C groups,respectively. The three groups performed similar grade of nausea and vomiting. Group A occurred less rate（ 32. 3%） of ≥ grade 2 treatment- related esophagitis than group B（ 50. 0%） and group C（ 51. 5%）. But more ≥grade 2 treatment- related pneumonitis showed in group A（ 67. 7%） than group B,C（ 53. 3%,48. 5%）. More than grade 3 myelo- suppression in group A（ 29. 0%） was less than group B,C（ 46. 7%,51. 5%）. Conclusion： Effect of combinations of CRT with chemotherapy in LANSCLC is still difficult to determine. Carry out induction chemotherapy properly for patients with LANSCLC still need a further study.