伽玛刀联合培美曲塞/卡铂同步与序贯治疗局部晚期非小细胞肺癌临床观察

Clinical effects of gamma knife combined with pemetrexed plus carboplatin in concurrent or sequential chemoradiotherapy of locally advanced non-small cell lung cancer

目的：观察体部伽玛刀联合培美曲塞／卡铂同步与序贯治疗局部晚期非小细胞肺癌的临床疗效及不良反应。方法125例局部晚期非小细胞肺癌患者，根据患者治疗方法分为3组。同步组30例，给予体部伽玛刀放疗，同步联合培美曲塞／卡铂方案化疗；序贯组31例，先给予培美曲塞／卡铂方案2周期化疗，后序贯体部伽玛刀放疗，再行2周期相同方案化疗；放疗组64例，单纯给予体部伽玛刀放疗。评价各组的临床疗效和不良反应。结果近期有效率同步组为83．33％、序贯组为77.42％、放疗组为73．44％，各组间差异无统计学意义（P＞0．05）；1、2年生存率及中位生存期：同步组分别为73．33％、43.33％和17．5个月，序贯组分别为64．52％、35．48％和15．4个月，放疗组分别为46．88％、23．44％和10．6个月；同步组优于序贯组，序贯组优于放疗组，提示有生存优势，但差异无统计学意义（P＞0．05）；同步组与放疗组比较，差异有统计学意义（P＜0．05）。各组不良反应均为Ⅰ～Ⅲ级，未出现Ⅳ级，并以骨髓抑制、胃肠道反应为主要表现。放射性食管炎和放射性肺炎发生率方面，3组间比较差异无统计学意义（ P＞0．05）；骨髓抑制和消化系统不良反应发生率方面，同步组、序贯组间比较，差异无统计学意义（P＞0．05），2组分别与放疗组比较，差异均有统计学意义（P＜0．05）。结论体部伽玛刀联合培美曲塞／卡铂方案同步治疗局部晚期非小细胞肺癌优于单纯伽玛刀放疗，并具有良好的安全性和可耐受性。

Objective To observe the clinical effects and adverse reactions of gamma knife combined with pemetrexed plus carboplatin in concurrent or sequential chemoradiotherapy of locally advanced non-small cell lung cancer（ LANSCLC） .Methods A to-tal of 125 cases of LANSCLC were randomly divided into 3 groups, in accordance with different therapeutic methods.The concurrent group （ or group A, 30 cases） received body gamma knife combined with pemetrexed plus carboplatin.The sequential group （ or group B, 31 cases） was given 2 weeks of chemotherapy with pemetrexed and carboplatin, then sequential body gamma knife radiotherapy and finally underwent two cycles of chemotherapy with the same regimen.The radiotherapy group （ or group C, 64 cases） was given just body gamma knife radiotherapy.Clinical therapeutic effects and adverse reactions were evaluated.Results The short-term effects for group A, group B and group C were respectively 83.33%, 77.42%and 73.44%, and no statistical significance could be seen when comparisons were made between them（P〈0.05）.The 1-2-year survival rate and the median survival time for group A were respectively 73.33%, 43.33%and 17.5 months, those for group B were respectively 64.52%, 35.48%and 15.4 months, and those for group C were respectively 46.88%, 23.44%and 10.6 months.Analyses indicated that group A was superior to group B, and group B was su-perior to group C, with the former having a better survival rate, and no statistical significance could be noticed when comparisons were made between them（P〉0.05）.However, there was statistical significance when comparisons were made between group A and group C （P〈0.05）.With regard to toxic reactions, all the adverse reactions were from gradeⅠ-Ⅲ, with bone marrow suppression and gastro-intestinal reactions as the main manifestations.GradeⅣadverse reaction never occurred.There was no statistical significance in the in-cidence rates of radiation-induced esophagiti and pneumonitis, when comparisons were made between the 3 groups（P〉0.05）.With re-gard to the incidence rates of bone marrow suppression and adverse reactions of the digest system, there was no statistical significance, when comparisons were made between group A and group B（P〉0.05）.However, statistical significance could be noted, when compari-sons were made between group A/B and group C（P〉0.05）.Conclusion Body gamma knife combined with pemetrexed and carboplatin in concurrent chemoradiotherapy was more superior to body gamma knife alone, furthermore it displayed better safety and higher tolerance.