替吉奥及吉西他滨分别联合奈达铂同步三维适形放射治疗Ⅲ期非小细胞肺癌的效果比较

Therapeutic effect comparison of Tiji＇ao or gemcitabine combined with nedaplatin and concurrent three-dimensional conformal radiotherapy for stage III non-small cell lung cancer

目的：观察替吉奥及吉西他滨分别联合奈达铂同步三维适形放疗治疗Ⅲ期非小细胞肺癌的效果。方法选取2013年1月至2015年9月我院收治的92例Ⅲ期非小细胞肺癌患者，用信封法随机分为替吉奥＋奈达铂＋三维适形放疗（ S-1＋NDP＋3D-CRT）组（观察组）46例和吉西他滨＋奈达铂＋三维适形放疗（ GEM＋NDP＋3D-CRT）组（对照组）46例，给予同步放化疗治疗，对两组患者近期疗效、生存质量改善情况及安全性进行分析比较。结果治疗后6个月，观察组与对照组治疗有效率分别为76.09％（35／46）和78.26％（36／46），临床获益率分别为95.65％（44／46）和93.48％（43／46），两组比较差异均无统计学意义（χ2值分别为0.062、0.517，P 均＞0.05）；观察组鳞癌有效率[77.78％（21／27）]较腺癌[73.68％（14／19）]比较差异无统计学意义（χ2＝0.103，P＞0.05），对照组鳞癌治疗有效率[80.00％（20／25）]与腺癌[76.19％（16／21）]比较差异无统计学意义（χ2＝0.097， P＞0.05）；观察组临床改善率[63.04％（29／46）]较对照组[56.52％（26／46）]比较差异无统计学意义（χ2＝0.489，P＞0.05）；观察组消化道反应发生率为86.96％（40／46）、放射性肺炎84.78％（39／46）、放射性食管炎86.96％（40／46），对照组分别为78.26％（36／46）、91.30％（42／46）、86.96％（40／46），两组间比较差异均无统计学意义（χ2值分别为0.21、0.22、0.06，P均＞0.05）；但在骨髓抑制方面，观察组WBC减少发生率为80.43％（37／46），PLT减少69.57％（32／46），对照组分别为91.30％（42／46）、93.48％（43／46），两组比较差异均有统计学意义（χ2值分别为10.43、19.37，P均＜0.05）。结论对于Ⅲ期非小细胞肺癌联合铂类化疗同步三维适形放疗，替吉奥与吉西他滨疗效相当，但毒副作用轻微，口服易吸收，更易于老年患者耐受，长期疗效仍待进一步随访。

Objective To observe the therapeutic effect of Tiji＇ao or gemcitabine combined with nedaplatin and concurrent three.dimensional conformal radiotherapy in the treatment of stage III non.small cell lung cancer（ NSCLC）.Methods A total of 92 patients with stage III NSCLC who were treated in the Heze Municipal Hospital from January 2013 to September 2015 were selected,and according to the envelope method were randomly divided into Tiji＇ao ＋ nedaplatin ＋ three.dimensional conformal radiotherapy（ S-1 ＋ NDP ＋ 3D-CRT） group （ Observation group, n = 46 ） and gemcitabine ＋ nedaplatin ＋ three.dimensional conformal radiotherapy（GEM＋NDP＋3D-CRT） group（Control group,n=46）.Rradiotherapy and chemotherapy trearment were performed concurrent,the short.term curative effect,the improvement of the quality of life and the safety of the two groups were compared.Results Six months after treatment,the curative efficiency（ RR） of Observation group and Control group was 76.09%（35/46） and 78.26%（36/45） respectively,clinical benefit rate（DCR） was 95.65%（ 44/46 ） and 93.48%（ 43/46 ） respectively, there were no statistically significant differences between two groups（ X2=0.062,0.517,P〉0.05）.There was no significant difference between RR of squamous cell carcinoma and adenocarcinoma in Observation group（ 77.78%（ 21/27） vs.73.68%（ 14/19） ,χ2=0.103,P〉0.05） ,and there was no significant difference between RR of squamous cell carcinoma and adenocarcinoma in Control group（ 80.00%（ 20/25） vs.76.19%（ 16/21） ,χ2=0.097,P〉0.05）.There was no significant difference＆amp;nbsp;between Observation and Control groups in term of clinical improvement rate（ 63.04%（ 29/46） vs.56.52%（ 26/46）,χ2=0.489,P〉0.05）.There were no significant differences between Observation and Control groups in terms of incidence of Gastrointestinal reactions,RP and esophagitis（86.96%（40/46） vs.78.26%（36/46）, 84.78%（39/46） vs.91.3% （ 42/46）, 86.96%（ 40/46） vs.86.96%（ 40/46）;χ2 = 3.95, 4.35, 0.34;P〉0.05）;but in terms of bone marrow suppression, reduction in incidence of white blood cells （ WBC ） , thrombocytopenia in Observation group were 80.43%（ 37/46 ） , 69.57%（ 32/46 ） , in the control group were 91.3%（ 42/46） , 93.48% （ 43/46 ） , there were significant differences between the two groups （χ2 =10.43, 19.37,P〈0.05 ）.Conclusion For stage Ⅲ non.small cell lung cancer combined with platinum.based chemotherapy concurrent three.dimensional conformal radiotherapy, Tiji＇ao and gemcitabine have equivalent efficacy,but Tiji＇ao has mild side effects,easy to oral absorption,easy to elderly patients with tolerance.But long.term efficacy remains to be further follow.up