Clinical study on concurrent chemoradiotherapy combined with Kanglaite injection in the treatment of regionally advanced unresectable non-small cell lung cancer

Objective： To evaluate the clinical effects and toxicity of concurrent chemoradiotherapy combined with Kanglaite injection in the treatment of regionally advanced unresectable non-small cell lung cancer. Methods： 48 patients with regionally advanced unresectable non-small cell lung cancer were randomized to two groups, 25 patients in the combination group （concurrent chemoradiotherapy ＋ Kanglaite） and 23 patients in the control group （concurrent chemoradiotherapy）. The combination group received chemotherapy of vinorelbine （NVB） plus cisplatin （DDP） regimen, radiotherapy was given with conventional fraction in 2 Gy per fraction and five fractions per week concurrently. The total tumor doses were 56-60 Gy. Combined with Kanglaite injection 200 mud for twenty-one days for two courses in the combination group, the control group was chemoradiotherapy only. Effects and toxicities were evaluated according to the criteria of WHO. Results： The CR rates in the combination group and control group were 24.0% （6/25） and 13.0% （3/23）, respectively （P 〉 0.05）. Response （CR ＋ PR） rates of combination group were 76.0 % （19/25） and 69.6% （16/23） in control group, P 〉 0.05. The incidence rates of grades 3-4 leukocytopenia, grades 3-4 digestive system （nausea and vomiting） and grades 3-4 esophagitis in the combination group and control group were 40.0% （10/25）, 8.0% （2/25）, 16.0% （4/25） and 69.6% （16/23）, 34.8% （8/23）, 43.5% （10/23）, respectively （P 〈 0.05）. KPS and body weight score significantly increased in combination group after the combined treatment, P 〈 0.05. Conclusion： Concurrent chemoradiotherapy combined with Kanglaite injection can relieve side effects of chemoradiotherapy in the treatment of regionally advanced unresectable non-small cell lung cancer, and improve quality of life. Kanglaite injection may increase effective rate of regionally advanced unresectable non-small cell lung cancer combined with concurrent chemoradiotherapy.

Phase I Study to Determine MTD of Docetaxel and Cisplatin with Concurrent Radiation Therapy for Stage Ⅲ Non-Small Cell Lung Cancer

Objective： To evaluate the maximum tolerated dose （MTD） of docetaxel （DCT） and cisplatin （DDP） concurrently with three dimensional （3D） conformal radiotherapy or IMRT for patients with locally advanced non-small cell lung cancer （stage IIIa and IIIb） after 2–4 cycles of induction chemotherapy. Methods： Fourteen patients with histological/cytological proven stage III non–small-cell lung cancer were eligible. 3D or IMRT radiotherapy （60-70Gy in 30-35 fractions, 6-7weeks, 2 Gy/fraction） was delivered concurrently with cisplatin and docetaxel, 2 cycles during concurrent chemoradiotherapy （CCRT）. The level I dosage was composed of 56 mg/m2 DCT, on day 1 and 28mg/m2 DDP, on day 1 and day 2. The level II was composed of 60 mg/m2 DCT, on day 1 and 30 mg/ m2 DDP, on day 1 and day 2. The level III was composed of 64 mg/m2 DCT, on day 1 and 32 mg/ m2 DDP, on day 1 and day 2. Results： Fourteen patients were allocated and finished concurrent chemoradiotherapy. The dose-limiting neutropenia was at the dose Level III （64 mg/m2） and occurred in 2 of 5 patients. No dose limiting non-hematologic or hematologic toxicity occurred in the other patients. Conclusions： Patients with locally advanced non-small cell lung cancer may tolerate 60mg/m2 docetaxel and 60mg/m2 cisplatin for 2 cycles during concurrent radiotherapy after 2-3 cycles of induction chemotherapy.

Initial outcome of induction chemotherapy followed by radiotherapy and concurrent weekly paclitaxel for stage Ⅲ non-small cell lung cancer

Objective： The aim of our study was to evaluate the toxicity and efficacy of induction chemotherapy （ICT） followed by three-dimensional conformal radiotherapy （3D CRT） and concurrent weekly paclitaxel on unresectable non-small cell lung cancer （NSCLC）. Methods： Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin （AUC = 5-6, dl） combined with paclitaxel （175 mg/m〈 dl）, then followed by weekly paclitaxel （40 mg/m2） and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 〈 31% and spinal cord dose 〈 50 Gy. Results： Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild （16/31）： all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious （29/31, grade 3 in 21）. Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grades 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grades 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. Conclusion： The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

Induction chemotherapy followed by weekly paclitaxel and carboplatin with concurrent radiotherapy in inoperable stage Ⅲ non-small cell lung cancers: results of a phase Ⅱ trial

Objective： several trials have suggested the superiority of concurrent chemoradiotherapy. It has been hypothesized that the addition of systemic dose sequential chemotherapy to concurrent chemoradiotherapy, as induction or as consolidation, might further improve survival rates. So we sought to evaluate the safety and efficacy of induction paclitaxel and carboplatin followed by weekly paclitaxel and carboplatin with concurrent radiotherapy in inoperable stage III non-small cell lung cancer （NSCLC）. Methods： Fifty-six patients with stage III inoperable NSCLC received induction chemotherapy with 2 cycles of paclitaxel 200 mg/m2 and carboplatin AUC-6 every 3 weeks then patients were assigned to concurrent chemoradiotherapy with paclitaxel 45 mg/m2 and carboplatin AUC-2 weekly along with concurrent radiotherapy at dose of 60 Gy （1.8 Gy/d x 5 d/week）. Results： Median age of the 56 eligible patients was 61 years, most of them were males （87.5%）. Squamous cell carcinoma was the most common pathological type （55.4%） and 85.7% had a performance status of 1. The majority of patients were presented with stage IIIB （62.5%）. Neutropenia was the most common toxicity during induction therapy （12.5% expressed grade 3） whereas esophagitis was the most common non hematologic adverse reaction during concurrent chemoradiotherapy （14.3% of grade 3）. The overall response rate was 71.6% with complete response in 19.6%. After median follow up of 20 months, the median survival time was 13 months （95% CI： 10.917-15.083） and 1 year overall survival rate was 53.6%. Conclusion： This regimen has demonstrated an acceptable toxicity profile and encouraging response to treatment. Evaluation of this regimen in larger number and a phase III trial are recommended.

Clinical study on concurrent and sequential therapy of intensity modulated radiation therapy (IMRT) combined with NP regimen chemotherapy in the treatment of middle and advanced non-small cell lung cancer

Objective: To evaluate the clinical effects of concurrent and sequential therapy for middle and advanced stage non-small cell lung cancer (NSCLC) useing IMRT combined with NP regimen chemotherapy. Methods: Eighty patients with middle and advanced stage NSCLC were randomized into two groups. Forty patients were underwent sequential therapy and other 40 patients were underwent concurrent therapy. IMRT was used in radiotherapy and NP regimen of vinorelbine+cispatin (NP) was used in chemotherapy. Results: (1) The overall response (CR+PR) rate was 75% in concurrent group and 45% in sequential group (P<0.05); (2) The treatment courses were 84 days and 140 days for concurrent group and sequential group respectively (P<0.05); (3) One-year survival rate in concurrent group was 72.4% and 52.3% in sequential group respectively; (4) The toxic effects can be tolerable by all of patients. Conclusion: The concurrent chemo-radiotherapy has better overall re- sponse, one-year survival rate and shorter treatment course than the sequential chemo-radiotherapy, so it is a better method for the treatment of middle and advanced stage NSCLC, but the long term survival rate will be studied.

Effect analysis of chemoradiotherapy after operation in patients with stage ⅢA non-small cell lung cancer

Objective:To investigate the effect of chemoradiotherapy after surgery onⅢA stage nonsmall cell lung cancer(NSCLC).Methods:A total of 156 NSCLC patients undergoing total pneumonectomy or pulmonary lobectomy were included in this study.The chemotherapy group (n=75) received the protocol of cisplatin(DDP) + gemcitabine(GEM) / docetaxel(DOC) / vinorelbine (NVB);the radiotherapy + chemotherapy group(n=81) received sequential chemoradiotherapy. The response rale,local control rale in1 to 2 years,overall survival(OS),progression-free survival(PFS) and adverse reactions were evaluated.Results:The overall response rate was obviously higher in radiotherapy + chemotherapy group(79.4%) than in chemotherapy group(56.8%) (P【0.01).The 1 year local control rates for chemotherapy group and radiotherapy + chemotherapy group were(69.1±7.9)%and(77.8±8.2)%respectively and the difference reached statistical significance (P【0.001).The 2 year local control rates were(42.1±6.1%and(61.5±6.9)%respectively(P【0.001). The difference in median follow-up time between the two groups did not reach statistical meaning(P】0.05),while the median PFS of two groups were 10.8 months and 16.9 months respectively(P【0.001).1-year and 3-year survival rates were obviously higher in radiotherapy + chemotherapy group than in chemotherapy group,and the difference reached statistical significance(P【0.05 or P【0.01).The adverse reactions manifested as hematological toxicity and digestive tract reaction in the two groups.In the radiotherapy + chemotherapy group,incidences of radiation-induced esophagus injury and lung injury were 24.7%and 34.6%respectively,all occurring within 2 to 6 weeks after the start of radiation and both below grade 2.Conclusions: Chemoradiotherapy after surgery can improve local control rate and reduce or prevent distant metastasis,but there are still many controversies.In clinical work,we should carefully evaluate each patient’s age,lung function,basic physical condilion scoring and complications to choose a therapeutic schedule that is suitable for the patient.

Feasibility of cetuximab and chemoradiotherapy combination in Chinese patients with unresectable stage Ⅲ non-small cell lung cancer:a preliminary report

Objective： In recent years, the combination of cetuximab and chemoradiotherapy （CRT） has been used to treat stage III non-small cell lung cancer （NSCLC）; however, limited data are available for Chinese patients. Herein, we report preliminary data from a phase I/II study testing the combination of cetuximab with inductive chemotherapy, followed by concurrent CRT （CCRT） in Chinese patients with stage III NSCLC. Methods： Eligibility criteria were Zubrod performance status （PS） 0-1, forced expiratory volume in 1 second （FEV1） 〉_1.2 L and adequate organ function. Enrolled patients received weekly cetuximab （initial dose of 400 mg/m2 on day 1 of week 1 and a maintenance dose of 250 mg/m2 on week 2 to the end of CCRT） with cisplatin/vinorelbine （NP） chemotherapy （every 3 weeks for 2 cycles from week 2, followed by two cycles of concomitant NP chemotherapy and intensity-modulated thoracic radiotherapy （TRT） （60-66 Gy/2 Gy）. The primary endpoints were toxicity and feasibility. All patients received positron emission tomography- computerized tomography （PET-CT） scans within the 2 weeks prior to enrollment. Univariate analyses were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumor-node- metastasis （TNM） stage, PS and smoking status and survival. Survival curves were generated for different populations using the Kaplan-Meier method and compared using a log-rank test. Results： Seventeen patients were enrolled and 16 completed the full regime. The overall response rate （ORR） was 58.8% and 82.3% after the induction and CCRT phases, respectively. With a median follow-up duration of 27.6 months, the median survival was 27.6 months [95% confidence interval （CI）： 11.3-43.9 months] with 1- and 2-year survival rates of 88.2% （95% CI, 60.6-96.9%） and 58.8% （95% CI, 60.6-77.8%）, respectively. Three patients remain progression-free to date, and the median progression-free survival （PFS） was 13.5 months （95% CI, 6.8-20.2 months）. No treatment-related death occurred; however, 76% of the patients experienced grade 3＋ adverse events （AEs）, including nansea/vomiting, intestinal obstruction, and esophagitis （〈6%）, while other AEs were mostly of hematological nature （71%）. The cut-off values for SUV-T and SUV-TOTAL were 11 and 20, respectively. Univariate analyses revealed SUV-TOTAL （P=0.027）, SUV-T （P=0.025）, and PS （P=0.006） as potential survival predictors, with a hazard ratio （HR） of 3.4, 3.7, and 9.9, respectively. Conclusions： The combination of cetuximab with induction chemotherapy followed by CCRT appears feasible and promising. Local and locoregional maximal SUVs, defined by 18F-FDG PET-CT scanning, may represent a prognostic indicator for long-term survival for these patients, which warrants further study.

The time-series behavior of systemic inflammation-immune status in predicting survival of locally advanced non-small cell lung cancer treated with chemoradiotherapy

Background:Systematic inflammation is believed to play a crucial role in tumorigenesis and metastasis.This study aims at evaluating the prognostic value of time-series behavior of systematic inflammation-immune status before and after definitive chemoradiotherapy(dCRT)in patients with locally advanced non-small cell lung cancer(LA-NSCLC).Methods:The relationship between systematic inflammation-immune score(SIS,defined as pretreatment periph-eral platelet count×neutrophil count/lymphocyte count)and the prognosis was tested in a retrospective study of 386 consecutive LA-NSCLC patients(Group A)with pretreatment SIS and 161 patients(Group B)with SIS before and one month after the dCRT.Results:SIS of 1400×10^(9)was found to be an optimal cutoffpoint to stratify the patients into high(>1400×10^(9))and low(≤1400×10^(9))SIS groups.Univariate and multivariate analyses revealed that the SIS,whether before or after dCRT,was an independent predictor for overall survival(OS),progress-free survival(PFS),and distant metastasis-free survival(DMFS).High SIS(>1400×10^(9))was shown to predict poor 3-year OS(P=0.006,hazard ratio[HR]=2.427),PFS(P=0.001,HR=2.442)and DMFS(P=0.015,HR=2.119).However,SIS was not related to local regional recurrence-free survival in either Group A(P=0.346)or Group B(P=0.486).Further,the area under the receiver operating characteristic curve of the SIS for OS was higher than the neutrophil count/lymphocyte count ratio,platelet count/lymphocyte count ratio,and other conventional clinic-pathological indices.Conclusions:The SIS is a stable and more sensitive survival predictor than other inflammation-based factors and conventional clinical indices,which may aid in more accurately stratifying patients for risk assessment and treatment decisions.

Therapeutic management options for stage Ⅲ non-small cell lung cancer

Lung cancer is the leading cause of cancer death worldwide.Majority of newly diagnosed lung cancers are non-small cell lung cancer(NSCLC), of which up to half are considered locally advanced at the time of diagnosis.Patients with locally advanced stage Ⅲ NSCLC consists of a heterogeneous population, making management for these patients complex.Surgery has long been the preferred local treatment for patients with resectable disease.For select patients, multimodality therapy involving systemic and radiation therapies in addition to surgery improves treatment outcomes compared to surgery alone.For patients with unresectable disease, concurrent chemoradiation is the preferred treatment.More recently, research into different chemotherapy agents, targeted therapies, radiation fractionation schedules, intensity-modulated radiotherapy, and proton therapy have shown promise to improve treatment outcomes and quality of life.The array of treatment approaches for locally advanced NSCLC is large and constantly evolving.An updated review of past and current literature for the roles of surgery, chemotherapeutic agents, radiation therapy, and targeted therapy for stage Ⅲ NSCLC patients are presented.

Clinical observation of gemcitabine and concomitant three-dimensional conformal radiotherapy in the treatment of locally advanced non-small cell lung cancer

Objective： To evaluate the clinical effect of gemcitabine and concurrent three-dimensional conformal radiation therapy （3D-CRT） for locally advanced non-small cell lung cancer （NSCLC）. Methods： From April 2002 to June 2005, 38 patients with inoperable stage Ⅲ NSCLC were treated with gemcitabine and 3D-CRT simultaneously. Chemotherapy consisted of intravenously gemcitabine 350 mg/m^2 on days 1, 8, 15, 22, 29, 36.3D-CRT was delivered up to a total dose of 60-64 Gy with a 2.0 Gy dose fraction per day, 5 days per week. Results： The overall response rates of primary tumor and mediastinum metastatic node were 86.8% （33/38） and 90.6% （29/32） respectively, and 91.7% （22/24） and 78.6% （11/14） for squamous cell carcinoma and adenocarcinoma respectively. The acute side effects of patients were mostly myelosuppression, nausea, vomiting, radiation-induced esophagitis and pneumonitis （RTOG 1/11）, however, all of them were cured. Conclusion： Concurrent application of gemcitabine and 3D-CRT can improve the overall response rate for locally advanced NSCLC without aggravating the side effects.

Computed tomography-based delta-radiomics enabling early prediction ofshort-term responses to concurrent chemoradiotherapy for patients withnon-small cell lung cancer

Objective:To explore the potential of computed tomography(CT)-based delta-radiomics in predicting early shortterm responses to concurrent chemoradiotherapy for patients with non-small cell lung cancer(NSCLC),in order to determine the optimal time point for the prediction.Methods:A total of 20 patients with pathologically confirmed NSCLC were prospectively enrolled in this study,who did not receive surgical treatment between February 2021 and February 2022.For each case,a total of 1,210 radiomic features(RFs)were extracted from both planning CT(pCT)images along with each of the subsequent three weeks of CT images.EffectiveΔRFs were selected using intra-class correlation coefficient(ICC)analysis,Pearson's correlation,ANOVA test(or Mann-Whitney U-test),and univariate logistic regression.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the potential to predict short-term responses of different time points.Results:Among the 1,210ΔRFs for 1-3 weeks,121 common features were retained after processing using ICC analysis and Pearson's correlation.These retained features included 54 and 58 of all time points that differed significantly between the response and non-response groups for the first and third months,respectively(P<0.05).After univariate logistic regression,11 and 44 features remained for the first and third months,respectively.Finally,eightΔRFs(P<0.05,AUC=0.77-0.91)that can discriminate short-term responses in both at 1 and 3 months with statistical accuracy were identified.Conclusion:CT-based delta-radiomics has the potential to provide reasonable biomarkers of short-term responses to concurrent chemoradiotherapy for NSCLC patients,and it can help improve clinical decisions for early treatment adaptation.

Pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC-contribution of IASLC recommendations

BACKGROUND Neoadjuvant treatment(NT)with chemotherapy(Ch)is a standard option for resectable stage III(N2)NSCLC.Several studies have suggested benefits with the addition of radiotherapy(RT)to NT Ch.The International Association for the Study of Lung Cancer(IASLC)published recommendations for the pathological response(PHR)of NSCLC resection specimens after NT.AIM To contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy(ChRT).METHODS We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020.After NT,all patients were evaluated for radiological response(RR)according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons.All histological samples were examined by the same two pathologists.PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes.RESULTS Forty patients underwent NT ChRT and 27 NT Ch.Fifty-six(83.6%)patients underwent surgery(35 ChRT and 21 Ch).The median time from ChRT to surgery was 6 wk(3-19)and 8 wk(3-21)for Ch patients.We observed significant differences in RR,with disease progression in 2.5%and 14.8%of patients with ChRT and Ch,respectively,and partial response in 62.5%ChRT vs 29.6%Ch(P=0.025).In PHR we observed≤10%viable cells in the tumor in 19(54.4%)and 2 cases(9.5%),and in the resected lymph nodes(RLN)30(85.7%)and 7(33.3%)in ChRT and Ch,respectively(P=0.001).Downstaging was greater in the ChRT compared to the Ch group(80%vs 33.3%;P=0.002).In the univariate analysis,NT ChRT had a significant impact on partial RR[odds ratio(OR)12.5;95%confidence interval(CI):1.21-128.61;P=0.034],a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5%increased probability for achieving downstaging(OR 8;95%CI:2.34-27.32;P=0.001).CONCLUSION We found significant benefits in RR and PHR by adding RT to Ch as NT.A longer follow-up is necessary to assess the impact on clinical outcomes.

奥希替尼联合同步放化疗治疗EGFR T790M突变的晚期非小细胞肺癌患者的临床效果

目的 探讨奥希替尼联合同步放化疗治疗表皮生长因子受体(EGFR)T790M突变的晚期非小细胞肺癌(NSCLC)患者的临床效果。方法 选取2016年3月至2018年9月本院收治的82例EGFR T790M突变的晚期NSCLC患者,采用随机数字表法将其分为对照组(41例)和观察组(41例)。对照组给予同步放化疗治疗,观察组给予奥希替尼联合同步放化疗治疗。比较两组的治疗效果。结果 观察组的疾病控制率、客观缓解率高于对照组,差异具有统计学意义(P<0.05)。观察组的Ⅰ+Ⅱ级皮疹、胃肠道反应、甲沟炎发生率高于对照组,差异具有统计学意义(P<0.05)。随访2年,观察组的无进展生存时间(PFS)为11.32(6.85,12.41)个月,长于对照组的7.29(4.91,9.32)个月(P<0.05);随访1、2年,观察组的生存率为75.61%、39.02%,高于对照组的56.10%、12.20%,差异具有统计学意义(P<0.05)。结论 奥希替尼联合同步放化疗治疗EGFR T790M突变的晚期NSCLC患者可提高近远期治疗效果,延长PFS,提升患者生存率,具有较高的临床应用价值。

安罗替尼联合信迪利单抗同步放化疗治疗驱动基因阴性非小细胞肺癌临床研究

目的探讨安罗替尼联合信迪利单抗同步放化疗一线治疗驱动基因阴性非小细胞肺癌(NSCLC)的临床疗效和安全性。方法选取苏州大学附属张家港医院2021年3月至2022年3月收治的驱动基因阴性NSCLC患者80例,按随机数字表法分为观察组和对照组,各40例。对照组患者给予NP化疗方案(顺铂30 mg/m^(2)+长春瑞滨25 mg/m^(2))+肺内原发灶和区域淋巴结放射治疗,观察组患者在对照组基础上加用安罗替尼联合信迪利单抗200 mg/m^(2)(第1天)。两组患者均以21 d为1个周期,共治疗4个周期。结果观察组客观缓解率和疾病控制率分别为72.50%和85.00%,均显著高于对照组的37.50%和52.50%(P<0.05)。治疗后,两组患者血清癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)水平均显著降低(P<0.05),生活质量调查核心问卷(QLQ-C30)和肺癌专用问卷(QLQ-LC13)评分均显著升高(P<0.05),且观察组均显著优于对照组(P<0.05)。观察组和对照组患者Ⅲ级及以上不良反应发生率相当(62.50%比52.50%,P>0.05)。所有患者的中位随访时间为15个月(12~24个月),失访3例。观察组中位无进展生存期(PFS)和中位总生存期(OS)分别为6.9个月和12.6个月,均显著长于对照组的4.3个月和8.9个月(Log-rankχ2=13.760,31.830,P<0.05)。结论安罗替尼联合信迪利单抗同步放化疗可提高驱动基因阴性NSCLC患者的临床疗效,改善生活质量,降低血清肿瘤标志物水平,延长生存时间,且安全性高。

舒格利单抗辅助同步放化疗对晚期肺癌患者肿瘤控制及预后的影响

目的:探究同步放化疗联合舒格利单抗对晚期肺癌患者肿瘤控制及预后的影响。方法:选取2022年1月至2023年1月于我院进行就诊的82例晚期肺癌肿瘤患者为研究对象,根据随机抽签法,分为对照组和实验组,各41例。对照组给予常规同步放化疗治疗(顺铂+依托泊苷)方案,实验组给予舒格利单抗辅助同步放化疗治疗方案。治疗6 w后使用实体瘤疗效评定标准和功能状态评分观察两组患者治疗后的短期疗效,使用流式细胞术观察T淋巴细胞亚群水平,采用Log Rank χ^(2)检验比较两组患者的半年生存率。结果:治疗6 w后,实验组的客观缓解率为65.85%,明显高于对照组的29.26%(P<0.05)。而实验组的疾病控制率为92.86%,较对照组的75.60%略高(P>0.05)。治疗结束后,实验组患者的生存质量稳定改善率为87.81%,高于对照组的41.46%(P<0.05)。治疗后,实验组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05);实验组CD8^(+)水平低于对照组(P<0.05)。随访6 m内,对照组患者病死率14.63%,实验组病死率4.88%,两组患者预后病死率差异有统计学意义(χ^(2)=4.203,P=0.040)。结论:同步放化疗联合舒格利单抗可提高晚期非小细胞肺癌的近期疗效及预后,改善患者免疫状态,提高生存质量,具有较好的临床应用价值。

同步放化疗联合中药健脾补肾法治疗局部晚期非小细胞肺癌临床研究

目的探讨同步放化疗联合中药健脾补肾法治疗局部晚期非小细胞肺癌的疗效。方法 126例局部晚期非小细胞肺癌患者,随机分为治疗组(同步放化疗联合中药健脾补肾)和对照组(同步放化疗)。治疗组68例(Ⅲa期28例,Ⅲb期40例),放疗开始紫杉醇135 mg/m2静滴d1,顺铂60 mg/m2静滴d3,每21～28天重复。放疗结束后给予原方案化疗。共化疗4周期。在化疗结束时口服健脾补肾中药三胶扶正合剂每天250 mL,放化疗结束后每日口服250 mL至疾病进展。对照组放化疗方案均与治疗组相同。结果全部病例随访5年以上,随访率95.24%。临床症状改善率治疗组为80.88%(55/68),对照组为65.5%(38/58),两组比较差异有统计学意义(χ2=3.82,P<0.05)。治疗组3、5年生存率分别为49.52%、21.49%,中位生存时间(MST)22个月;对照组3、5年生存率分别为36.73%、15.14%,中位生存时间(MST)17个月;两组比较差异有统计学意义(χ2=4.94,P<0.05;χ2=5.94,P<0.05)。两组生存曲线比较差异有统计学意义(χ2=5.18,P<0.05)。治疗组Ⅲ～Ⅳ度白细胞下降的发生率20.59%低于对照组的72.41%,两组比较差异有统计学意义(χ2=31.3,P<0.05)。治疗组放射性食管炎、放射性肺炎发生率分别为30.88%(21/68)1、3.23%(9/68),低于对照组的发生率,两组比较差异有统计学意义(χ2=8.38和10.13,P<0.05)。结论同步放化疗联合健脾补肾中医药治疗局部晚期非小细胞肺癌,近期疗效、临床症状改善、3、5年远期生存率较单纯同步放化疗提高,毒性下降。

两周期诱导化疗后Ⅲ期非小细胞肺癌同步放化疗的疗效分析

背景与目的 近年来,放疗联合化疗的综合治疗已取代单纯放疗成为不能手术的局部晚期 NSCLC的标准治疗方法。本研究拟在比较两周期诱导化疗后Ⅲ期非小细胞肺癌(NSCLC)同步放化疗与单 纯放疗的临床疗效和毒性反应。方法 将92例经过两周期以顺铂(DDP)为主诱导化疗后的Ⅲ期NSCLC患 者(ⅢA期26例,ⅢB期66例)随机分组,其中47例进入同步放化疗组,45例进入单独放疗组。同步放化疗 组化疗方案:异长春花碱(NVB)15～18mg/m2第1、8天,DDP60mg/m2第1天;放射治疗从第1天开始, 6MV X射线照射,二野等中心照射DT40Gy/4～4.5周后缩野,追加剂量至DT60～65Gy/6～6.5周。单独 放疗组:放射治疗方案同同步放化疗组。结果 所有患者均顺利完成治疗。同步放化疗组完全缓解率(CR) 为14.9%,部分缓解率(PR)为44.7%,单独放射治疗组CR6.7%,PR44.4%,两组的CR有显著性差异(P< 0.05),而有效率无显著性差异(P>0.05)。同步放化疗组的1、2年生存率分别为65.9%、42.5%,单独放疗 组为53.3%、33.3%,无显著性差异(P>0.05)。同步放化疗组的1、2年局控率分别为63.8%、53.2%,单独 放疗组为51.1%、44.4%,有显著性差异(P<0.05)。同步放化疗组Ⅲ+Ⅳ级的放射性食管炎和白细胞下降 发生率分别为21.2%和12.

周剂量多西紫杉醇和顺铂同步放化疗治疗42例Ⅲ期非小细胞肺癌患者的临床观察

目的评估周剂量多西紫杉醇和顺铂同步放化疗治疗Ⅲ期非小细胞肺癌的疗效及毒副作用。方法 42例不能手术的Ⅲ期非小细胞肺癌患者(Ⅲa期18例,Ⅲb期24例),接受多西紫杉醇20 mg/m2、顺铂25 mg/m2每周给药1次化疗和总量60Gy的同步放疗(2Gy/次,5次/周)。结果近期有效率为76.2%,平均随访22个月,中位生存期为17.2个月,中位局部无进展生存时间为13.5个月,1、2、3年的生存率分别为78.6%、35.7%、19.5%。放化疗的毒性反应主要是骨髓抑制,放射性食管炎和胃肠道反应,经对症处理能完成治疗,无治疗相关死亡。结论周剂量多西紫杉醇和顺铂同步放化疗治疗Ⅲ期非小细胞肺癌具有较好的近期与远期疗效,不良反应可耐受。

不能手术局部晚期非小细胞肺癌同步或序贯放化疗85例临床分析

目的:评价不能手术局部晚期非小细胞肺癌(NSCLC)患者同步或序贯放化疗的疗效和不良反应。方法:2011年7月至2013年12月间初治接受同步或序贯放化疗的85例患者入组本研究,其中45例同步放化疗患者列入A组,40例序贯放化疗患者列入B组。A组采用放疗同步紫杉醇、顺铂化疗,B组采用单纯放疗,放疗结束后行紫杉醇、顺铂化疗。两组放疗方法相同,均为三维适型放疗,剂量60Gy/30f。对比两组治疗的疗效、不良反应和1、2年生存率。结果:85例患者均可评价疗效,随访率100%。A组与B组有效率分别为73.3%和50.0%(P<0.05);1年局部控制率分别为51.1%和30.0%(P<0.05);1年生存率分别为62.2%和42.5%(P>0.05);2年生存率分别为37.8%和17.5%(P<0.05)。A组≥Ⅲ级放射性肺炎、放射性食管炎及Ⅲ~Ⅳ级骨髓抑制的发生率分别为6.7%、11.1%和28.9%,B组分别为5.0%、10.0%和27.5%。两组不良反应相似,均可耐受。结论:局部晚期NSCLC同步放化疗的疗效优于序贯放化疗,不良反应可耐受,同步放化疗是不能手术的局部晚期NSCLC标准治疗方法。

诱导化疗和紫杉醇每周同期化疗结合三维适形放射治疗不能手术的Ⅲ期非小细胞肺癌的初步结果

背景与目的:局部晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)单纯放疗局部控制率差,放化疗综合治疗及放疗剂量递增成为提高局控的主要研究方向,但最佳治疗模式尚未确定。本研究观察诱导化疗和三维适形放射治疗(three-dimensionalconformalradiotherapy,3DCRT)联合每周紫杉醇治疗NSCLC的毒性及初步疗效。方法:Ⅲ期NSCLC患者予紫杉醇(175mg/m2,d1)加卡铂(AUC=5～6,d1)诱导化疗2～4疗程,化疗后3～4周内开始3DCRT,剂量在满足V20≤31%,脊髓≤50Gy的条件下给予尽可能的高,联合每周紫杉醇40mg/m2同期化疗。结果:31例患者入组,诱导化疗毒性可耐受。同期放化疗期间,3例因3～4度急性毒性中止治疗,2例因身体虚弱分别中断治疗7天及12天,其余26例按计划完成治疗。白细胞下降发生率为51.6%(16/31,1例为3度,余为1～2度);3度淋巴细胞下降发生率达67.7%(21/31)。主要急性毒性为放射性食管炎和放射性肺炎,3度放射性食管炎3例,3～4度放射性肺炎2例。1～4度后期食管损伤各有1例发生;肺纤维化均不超过2度。肺原发灶总有效率(CR+PR)为74.1%(CR1例,PD2例)。中位生存时间18.5个月,1、2、3年生存率分别为74.2%、41.9%、34.6%,中位局部无进展生存时间为14.3个月,1、2、3年局部无进展生存率分别为64.5%、32.3%、20.5%。结论:诱导化疗后3DCRT结合每周紫杉醇治疗局部晚期NSCLC能为大多数患者耐受,初步疗效令人鼓舞。