调强放疗联合PC化疗方案治疗局部晚期肺腺癌的疗效再分析

IMRT combined chemotherapy regimen PC efficacy of locally advanced lung adenocarcinoma reanalysis

目的：观察调强放疗联合培美曲赛＋顺铂（PC）化疗方案治疗局部晚期肺腺癌的临床疗效。方法：00例局部期肺腺癌患者，随机分为 P 组52例，E 组48例。P 组采用调强放疗联合 PC 方案同步化疗，E 组采用调强放疗联合依托泊苷＋顺铂（EP 方案）同步化疗。P 组方案：培美曲赛500 mg/ m^2、顺铂75 mg/ m^2静滴，d1，21 d 重复。E 组方案：顺铂50 mg/ m^2，d1，d8静滴；依托泊苷50 mg/ m^2，第1~5天静滴，28 d 重复。每组放疗剂量60 Gy/30次，放疗期间同步化疗2周期，共完成化疗4周期。观察并比较两组患者近期疗效、中位生存率和不良反应发生情况。结果90例患者按计划完成治疗，其余10例未完成第四次化疗。可评价疗效的90例患者中，P 组总有效率81.8％；E 组总有效率60.8％，P 组总有效率高于 E 组，差异有统计学意义（ P 〈0.05）。两组均无治疗相关死亡病例。P 组和 E 组2年生存率分别为63.6％和58.6％（ P ﹥0.05）；P、E 两组2年局部无进展生存率（LPF）分别为：59.1％和52.1％；2年无区域进展生存率（RPF）分别为：45.4％和45.6％；2年无远处转移生存率（DMF）分别为：40.9％和41.3％；P 组与 E 组2年 LPF、RPF和 DMF 差异均无统计学意义（ P ﹥0.05）；两组不良反应以Ⅰ~Ⅱ级反应为主，只有少数Ⅲ级反应，两组不良反应差异均无统计学意义（ P ﹥0.05）。结论调强放疗联合 PC 化疗方案治疗局部晚期肺腺癌的近期疗效优于调强放疗联合EP 化疗方案，毒副作用轻，临床可以耐受。

Objective The aim of this study is to observe the clinical effects of intensity - modulated radiotherapy combined with PC regi-men chemotherapy in treatment of locally advanced lung cancer. Methods 100 patients with localized lung adenocarcinoma patients were random-ly divided into 52 cases of the P group,E group（48 cases）. The patients of group P were given intensity - modulated radiotherapy combined with pemetrexed ＋ cisplatin（PC scheme synchronization chemotherapy）,The patients of group E were given intensity - modulated radiotherapy com-bined with etoposide ＋ cisplatin（EP）synchronous chemotherapy. The patients of group P were given：pemetrexed 500 mg/ m^2 ,and cisplatin 75 mg/ m^2 IVGTT,D1,21 d repeat. The patients of Group E were given Cisplatin 50 mg / m^2 ,d1,d8 of intravenous drip,and etoposide in 50 mg/d,d1 ~ d5 of intravenous drip,28 d repeat. The radiotherapy dose of each group was 60 Gy/ 30. A total of 2 cycles of chemotherapy during radio-therapy,and chemotherapy were maintained for 4 cycles. To observe and compare the clinical effects of patients in two groups,the other indexes included the one - year survival rate and the occurrence of adverse reactions. Results 90 patients completed the treatment as planned,the remai-ning six cases did not finish fourth chemotherapy. To evaluate the efficacy of 90 patients,total response rate of group P was 81. 8% ;E group was 60. 8% ,compared with the two groups（ P 〈 0. 05）. There were no treatment - related deaths. The 2 - year survival rate of the P group and E, respectively,63. 6% and 58. 6%（ P ﹥ 0. 05）. The 2 - year of local progression - free survival（LPF）of two group,respectively：59. 1% and 52. 1% . The 2 - year regional progression - free survival（RPF）were：45. 4% and 45. 6% ,respectively. The 2 - year distant metastasis - free survival rate（DMF）were as follows：40. 9% and 41. 3% ,respectively. The P group E compared years LPF,RPF and DMF. There was no statis-tical significance（ P ﹥ 0. 05）. Two adverse reactions to the main stage Ⅰ ~ Ⅱ,Ⅲ level only a few reactions. The two groups showed no signifi-cant adverse effects（ P ﹥ 0. 05）. Conclusion The efficacy of intensity - modulated radiotherapy combined with PC regimen chemotherapy in treatment of locally advanced lung cancer was superior to that of intensity - modulated radiotherapy combined with EP regimen chemotherapy.