培美曲塞或紫杉醇同期放化疗治疗局部晚期老年肺腺癌对比研究

Comparative Study of Pemetrexed or Paclitaxel Combined with Concurrent Chemoradiotherapy for Elderly Patients with Locally Advanced Lung Adenocarcinoma

目的：探讨培美曲塞或紫杉醇联合同期放疗治疗局部晚期老年肺腺癌的近期疗效及急性不良反应。方法对经组织学确诊为ⅢA或ⅢB期肺腺癌的老年患者60例根据治疗方法分为实验组、对照组，实验组采用培美曲塞[500 mg/（m2＆#183; d）]治疗，共2个周期；对照组采用紫杉醇（50 mg/m2）治疗，每周1次，共6～7个周期。化疗同时给予三维适形放疗（3DCRT），处方剂量为60～70 Gy，6～7周完成。结果有效率（CR＋PR）实验组为76．7％（23/30），对照组为66．7％（20/30），2组差异无统计学意义（P＞0．05）；不良反应主要包括恶心呕吐、中性粒细胞减少、血小板减少、血红蛋白下降、放射性肺炎、放射性食管炎（Ⅰ-Ⅳ度），其中对照组恶心呕吐发生率为86．7％，高于实验组（53．3％），差异具有统计学意义。而实验组中性粒细胞减少发生率低，与对照组相比，差异具有统计学意义（P＜0．05）。结论培美曲塞或紫杉醇结合同期放疗治疗局部晚期老年肺腺癌近期疗效良好，但培美曲塞进行化疗的不良反应更低，值得临床推广应用。

Objective To study the short-term effects and toxicities of pemetrexed or paclitaxel combined with concur-rent chemoradiotherapy for elderly patients with locally advanced lung adenocarcinoma .Methods 60 elderly patients who were histologically confirmed to be stage ⅢA orⅢB lung adenocarcinoma were divided into the treatment group and the control group , each with 30 cases.The treatment group was given pemetrexed 500 mg/（m2· d） for 2 cycles.The control group was given pacli-taxel （50 mg/m2）,once a week for 6-7 weeks.Both groups received three dimensional conformal radiation therapy （3DCRT） at the same time,the prescription dose was 60-70 Gy for 6-7 weeks.Results The overall response rates （ CR＋PR） of the treat-ment group and the control group were 76.7%（23/30）and 66.7%（20/30）,respectively.There was no statistical difference be-tween the 2 groups（P〉0.05）.The main adverse reactions were nausea,vomiting,neutropenia,thrombocytopenia,anemia,radia-tion induced-pneumonitis and radiation induced-esophagitis （Ⅰ-Ⅳdegree）.The incidence of nausea and vomiting of the control group （86.7%） was higher than that of the treatment group （53.3%）.There was statistical difference between the 2 groups.The incidence of neutrophilic granulocytopenia of the treatment group was higher than of the control group .There was significant differ-ence between the 2 groups （P〈0.05）.Conclusion Pemetrexed or paclitaxel combined with concurrent chemoradiotherapy for elderly patients with locally advanced lung adenocarcinoma have good short -term curative effects ,and pemetrexed for chemothera-py has fewer complications .It is worthy of clinical application .