同步放化疗治疗局部晚期非小细胞肺癌的Ⅲ期临床研究  

Study on concurrent chemotherapy and radiotherapy for locally advanced unresectable (stage Ⅲ) non-small cell lung cancer

作　　者：王玉洲[1] 杨志雄[1] 廖思海[1] 余忠华[1] 杨志诚[1] 李丽霞[1] 

机构地区：[1]广东医学院附属医院肿瘤中心,广东湛江524001

出　　处：《临床肿瘤学杂志》2009年第5期390-395,共6页Chinese Clinical Oncology

基　　金：广东省医学科学技术研究基金面上项目(A2006487)

摘　　要：目的:探讨周剂量长春瑞滨、顺铂同步放射治疗局部晚期非小细胞肺癌的近期疗效和毒性反应。方法:87例局部晚期非小细胞肺癌患者,KPS评分≥70,中位年龄57岁(35～70岁),随机分为同步组(28例)、序贯组(30例)和放疗组(29例)。放射治疗采用6～8MV加速器,常规分割,总剂量60～64Gy;化疗采用长春瑞滨与顺铂联合;同步组化疗为长春瑞滨12.5mg/m2,顺铂20～40mg/m2,每周一给药1次,共6～7次;序贯组化疗为长春瑞滨20mg/m2,d1、d8,顺铂80～100mg/m2,d1或分为d1～d3。每3周为1周期,共3～4周期。3组用药前均给予预处理。治疗后按WHO标准评价疗效和毒性。结果:87例中有1例死亡,86例完成治疗并可评价疗效和毒性。3组有效率分别为75.00%、58.62%和44.82%(P<0.05)。平均生存时间分别为15.7个月、13.5个月及8.6个月。1年生存率分别为71.43%、60.88%和35.98%(P=0.013 7)。ⅢA期患者1年生存率分别为75.00%、57.14%和44.44%(P=0.339 4)。ⅢB期患者1年生存率分别为70.00%、63.64%和35.00%(P=0.033 6)。3组毒副反应主要为骨髓抑制,未见明显肺及食道毒性。治疗后KPS评分及体重同步组和序贯组均得到改善。结论:同步放化疗治疗局部晚期非小细胞肺癌疗效明显优于序贯放化疗及单纯放疗,患者的生存质量提高而未明显增加肺、食道的毒性。Objective：To explore the efficacy of radiotherapy sensitization of vinorelbine and cisplatin in order to evaluate the clinical effect and toxicity of concurrent weekly-dose vinorelbine and cisplatin chemotherapy and radiation therapy for locally advanced non-small cell lung cancer. Methods：From January 2004 to June 2006, 87 patients were allotted to this clinical phase Ⅲ studio. Among 87 patients, there were 56 males and 31 females, with a median age of 57 years（range 35 to 70）. Karnofsky scores were more than 70 for all cases. They were randomized into 3 groups, 28 in concurrent chemo-radiotherapy arm, 30 in the sequential chemo-ra- diotherapy ann and 29 in the radiotherapy in our institution. All patients received conventional radiotherapy （6-SMV accelerator linear）. Radiotherapy lasted more than 6 weeks and the total dose was 60-66Gy. The daily fraction was 2 Gy, administered 5 days a week. Chemotherpy consisted of cisplatin and vinorelbine. The concurrent arm consisted of cisplatin （20-40mg/m^2 on Monday weekly）, and vinorelbine（ 12. 5mg/m^2 on Monday weekly）. This chemotherapy was repeated every week and was administered in radiotherapy courses. The sequential arm consisted of cisplatin（80-100mg/m^2 on day 1 or 30 mg/m^2 on day 1-3）, and vmorelbme（20mg/m^2 on day 1, 8 ）. This chemotherapy was repeated every three weeks and was administered in two courses. To evaluate the effect according to WHO standard and toxicity after the treatment. Results：Eighty-seven patients were enrolled and 86 were included in response and toxicity evaluation. Four of 28 patients achieved a complete response, and 17 achieved a partial response for an overall response rate of 75.00% in the concurrent ann. Three of 29 patients achieved a complete response, and 13 achieved a partial response for an overall response rate of 58. 62% in the sequential arm. And in the radiotherapy arm, there was l patient achieved a complete response, and 13 achieved a partial response for an overall response rate of 44. 82

关 键 词：肺肿瘤 放射治疗 化学治疗 顺铂 长春瑞滨 

分 类 号：R734.2[医药卫生—肿瘤]