93例Ⅲ期非小细胞肺癌同步放化疗加巩固化疗与序贯放化疗的对比研究

目的分析Ⅲ期不能手术非小细胞肺癌同步放化疗加巩固化疗与序贯放化疗的近、远期疗效及毒副反应。方法回顾分析2007年2月-2010年6月收治的Ⅲ期不能手术的非小细胞肺癌患者93例,序贯组50例,同步加巩固组43例。序贯组:先行2-6周期(中位2周期)化疗后开始放疗,放疗后再行0-4周期(中位2周期)化疗。同步组:放疗同步2周期化疗(每隔3周),放疗后行2-4周期(中位2周期)同方案巩固化疗,均为第3代TP/NP/GP方案。放疗采用二维前后对穿野照射DT36-40 Gy/18-20f后三维适形放疗推量至DT56-70 Gy/28-35(f中位DT64 Gy)或三维适形放疗DT50-74 Gy/25-37(f中位DT62 Gy)。结果同步加巩固与序贯组客观有效率分别为76.7%、54.0%(P<0.05);中位无进展时间、中位生存时间分别为16.0个月、18.0个月及10.0个月、12.5个月;1、2、3年生存率分别为83.7%、48.8%、20.9%及52.0%、20.0%、2.0%(P<0.05)。同步加巩固组远地转移率明显低于序贯组(P<0.05),局部复发率两组无统计学差异。毒副反应主要为放射性肺炎、放射性食管炎、消化道反应及血液毒性,其中Ⅲ-Ⅳ级消化道反应及血液毒性同步加巩固组高于序贯组,有统计学差异。结论对于Ⅲ期非手术NSCLC同步放化疗加巩固化疗与序贯放化疗相比,可以提高客观有效率、延长无进展生存及总生存时间、降低远地转移率,虽然消化道及血液学毒性增加,但患者可以耐受。

Concurrent chemoradiotherapy followed by consolidation chemotherapy and sequential chemoradiotherapy for stage III non-small cell lung cancer: comparison in 93 patients

Objective To compare the efficacy and toxicity of concurrent chemoradiotherapy followed by consolidation chemotherapy(CCRT-CT) and sequential chemoradiotherapy(SCRT) in the treatment of stage III non-small cell lung cancer.Methods From February,2007 to June,2010,93 patients with unresectable stage III non-small cell lung cancer were treated with SCRT or CCRT-CT.SCRT group(50 cases) received radiotherapy after 2-6 cycles of chemotherapy(median 2 cycles) followed by 0-4 cycles(median 2 cycles) of chemotherapy.CCRT-CT group(43 cases) received 2 cycles of chemotherapy every 3 weeks with concurrent radiotherapy followed by 2-4 cycles(median 2 cycles) of chemotherapy with the same drugs.The chemotherapy consisted of cisplatin plus gemcitabine,docetaxel or vinorelbine.Radiotherapy was administered using two-dimensional conformal irradiation(36-40 Gy/18-20f) followed by three-dimensional conformal boost to 56-70 Gy/28-35f(median DT64Gy) or using three-dimensional conformal irradiation 50-74 Gy/25-37f(median DT62Gy).Results The response rates were 76.7% and 54.0% in CCRT-CT and SCRT group,respectively(P<0.05).The median progression-free time in the two groups was 16.0 and 10.0 months,with the overall survival time of 18.0 and 12.5 months,respectively.The 1-,2-and 3-year overall survival rates were 83.7%,48.8% and 20.9% in CCRT-CT group and 52.0%,20.0%,and 2.0% in SCRT group,respectively(P<0.05).CCRT-CT group showed a significantly lower rate of distant metastasis than SCRT group(P<0.05),but the local recurrence rate was similar between the two groups.The main side effects included radiation pneumonitis,radiation esophagitis,nausea/vomiting and anemia/leucopenia/thrombocytopenia.CCRT-CT group had a significantly higher rate of III-IV grade nausea/vomiting and anemia/leucopenia/thrombocytopenia than SCRT group.Conclusion Compared to SCRT,CCRT-CT can improve the response rate,progression free survival and overall survival and decrease the rate of distant metastasis,but is associated with a higher toxicity.