含铂药物的“第二代”和“第三代”化疗方案联合放疗对晚期非小细胞肺癌的疗效比较  

Comparison of Treatment Efficacy of the Second and the Third Generations of Chemoradiotherapy Regimens Containing Platinum on Advanced Non-small Cell Lung Cancer

作　　者：王奕鸣[1] 郭良君[1] 李丽莎[1] 李平[1] 郑坚[1] 李力[1] 

机构地区：[1]暨南大学附属第一医院肿瘤科,广东广州510630

出　　处：《癌症》2005年第12期1514-1517,共4页Chinese Journal of Cancer

摘　　要：背景与目的:以铂类药物为基础的化疗方案对晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)治疗效果较其他方案好,“第三代”化疗药物比“第二代”有优势。本文旨在比较含铂药物的“第二代”和“第三代”化疗方案联合放疗治疗晚期(Ⅲ～Ⅳ期)NSCLC的疗效。方法:全组病例均采用化疗、放疗、化疗的“夹心”治疗。采用“第二代”的化疗方案为MVP、IVP、EP、VDS+DDP共24例。“第三代”的化疗方案为NP、TP和GP共23例,两组患者资料经χ2检验具有可比性。两组放疗均采用60Coγ射线常规外照射,剂量为65～76Gy。用Kaplan-Meier法计算生存率,两组间差异比较用log-rank检验。结果:“第二代”治疗组的有效率(CR+PR)为41.7%(10/24),“第三代”治疗组的有效率(CR+PR)为56.5%(13/23),差异无显著性(χ2=0.53,P=0.47)。“第二代”治疗组和“第三代”治疗组的中位肿瘤进展时间(mediantimetoprogression,MTTP)分别为6.00个月和12.60个月,差异有显著性(χ2=6.93,P=0.01)。第二代和第三代治疗组中位生存期分别为9.0个月、14.0个月,差异有显著性(U检验:Z=-2.17,P=0.03);1年生存率分别为30.7%、56.3%。“第二代”治疗组中无2年生存者,“第三代”治疗组中2年生存率为15.6%,差异有显著性(χ2=6.59,P=0.01)。两组的主要不良反应为骨髓抑制、恶心呕吐以及放疗引起的放射性肺部反应、放射性食管反应。Ⅲ～Ⅳ级的中性粒细胞减少发生率以“第二代”治疗组较多见,而Ⅲ～Ⅳ级的放射性食管反应以“第三代”治疗组较多见,但均无统计学意义。结论:初步显示含铂药物的“第三代”化疗方案联合放疗治疗晚期NSCLC比“第二代”在生存时间上有一定优势,值得进一步进行临床研究。BACKGROUND ＆ OBJECTIVE： Platinum-based chemotherapy regimens are better than other regimens when treating patients with advanced non-small cell lung cancer （NSCLC）. The third generation of platinum-based regimens {NP [Navelbine （NVB）, cisplatin （DDP）], TP （Taxol, DDP）, GP （Gemzar, DDP）} is better than the second generation {MVP [mitomycin （MMC）, desacetylvinblastin amide （VDS）, DDP], MIP [MMC, ifosfamide （IFO）, DDP], EP [etopside （VP-16）, DDP], VDS＋DDP}. This study was to compare the efficacy between the second and the third generations of platinum-based regimens combined with radiotherapy on advanced non-small cell lung cancer （NSCLC）. METHODS： From Jul. 1999 to Dec. 2001, 47 pathologically confirmed advanced NSCLC patients received chemoradiotherapy. 24 received the second generation of platinum-based regimens, 23 received the third generation; all patients received routine external irradiation of ^60Co （65-76 Gy）. Characteristics of the patients were comparable. Kaplan-Meier analysis was used to evaluate survival rates, and log-rank test to study differences between the 2 groups. RESULTS： The objective response rates were 41.7% in the second generation group, and 56.5% in the third generation group （χ^2=0.53, P=0.47）. The median time to progression and median survival time were significantly longer in the third generation group than in the second generation group （12.6 months vs. 6.0 months, χ^2=6.93, P=0.01; 14.0 months vs. 9.0 months, Z=-2.17, P=0.03）. The 1-, and 2-year survival rates were significantly higher in the third generation group than in the second generation group （56.3% vs. 30.7%, 15.6% vs. 0%, χ^2=6.59, P=0.01）. The major adverse events were leukocytopenia, nausea and vomiting, radiation-induced esophagitis and pneumonia, which were tolerable. CONCLUSIONS： The third generation of platinum-based regimens in combination with radiotherapy for advanced non-small lung cancer may be more advantageous over the second generation of

关 键 词：肺肿瘤 癌 非小细胞性 药物疗法 联合 放射疗法 疗效 

分 类 号：R734.2[医药卫生—肿瘤] R730.53[医药卫生—临床医学]