肺腺癌术后pN_2期患者同步或序贯放化疗疗效对比观察  

Comparison of the outcome of concurrent chemoradiotherapy and sequential chemoradiotherapy in postoperative patients with pN_2 lung adenocarcinoma

作　　者：徐志勇[1] 唐艳娜 蒿艳蓉[1] 吕艳茹[1] 谢嫣嫣[1] 舒留洋 周若琳 冯泽斌 卢昌超[1] 陆合明[1] 谢丹敏 杨姣[1] 钟永泷[1] 林辉[1] 冯国生[1] XU Zhi-yong;TANG Yan-na;HAO Yan-rong;LV Yan-ru;XIE Yan-yan;SHU Liu-yang;ZHOU Ruo-lin;FENG Ze-bin;LU Chang-chao;LU He-ruing;XIE Dan-rain;YANG Jiao;ZHONG Yong-long;LIN Hui;FENG Guo-sheng(Clinical Tumor Center,People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,P.R.China)

机构地区：[1]广西壮族自治区人民医院临床肿瘤中心,广西南宁530021

出　　处：《中华肿瘤防治杂志》2018年第23期1654-1657,1669,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西科学研究与技术开发计划(14124004-1-19);国际临床试验注册项目(NCT 02132143);广西医疗卫生适宜技术研究与开发项目(S201421-06);广西重点研发计划(AB16380226)

摘　　要：目的肺腺癌术后同侧纵隔内和(或)隆突下淋巴结转移(pN_2期)患者,术后辅助治疗是进行同步放化疗还是序贯放化疗无明确定论。本研究探讨培美曲塞/顺铂同步调强适形放射治疗(intensity-modulated radiation therapy,IMRT)与培美曲塞联合顺铂序贯IMRT两种模式治疗肺腺癌术后pN_2期患者毒性及安全性,并分析两种治疗模式对患者无病生存期(disease-free survival,DFS)及总生存期(overall survival,OS)影响。方法将2014-01-01—2016-12-31广西壮族自治区人民医院临床肿瘤中心62例符合入组标准的肺腺癌术后pN_2期患者按照随机数字表法分为同步放化疗组(同步组)和序贯放化疗组(序贯组)。同步组:患者术后2～4周内开始同步放化疗,IMRT 50～60Gy/5～6周,放疗第1天同步给予培美曲塞500mg/m2+顺铂75mg/m2,配合水化,21d为1个周期,放疗期间同步给予2个周期化疗,随后继续给予2个周期巩固化疗。序贯组:患者术后2～4周内先接受4个周期辅助化疗,然后再接受IMRT,化疗方案和IMRT剂量与同步组相同。观察患者近期毒副作用及远期预后。结果同步组中位DFS为16.18(95%CI:14.44～17.92)个月,序贯组为15.43(95%CI:12.70～18.16)个月,χ~2=1.028,P=0.310;同步组中位OS为24.13(95%CI:19.20～29.07)个月,序贯组为23.90(95%CI:17.54～30.26)个月,χ~2=0.379,P=0.538,两种治疗模式在生存获益方面差异无统计学意义。两组骨髓抑制作用比较,差异无统计学意义,χ~2=1.060,P=0.303。结论 pN_2期肺腺癌患者术后无论是采取同步放化疗还是序贯放化疗均是可行方案,可根据患者个体差异适当选择合适治疗模式。OBJECTIVE Now there is no definite conclusion that adjuvant therapy is synchronous radiotherapy or continuous inertial radiotherapy in ipsilateral mediastinal and/or subcarinal lymph node metastasis(pN2 positive)lung cancer patients after surgery.The aim of this study was to compare the toxicity and safety of pemetrexed/cisplatin synchronous intensity-modulated radiation therapy(IMRT)and pemetrexed/cisplatin sequential IMRT in these patients,and analyze the disease-free survival(DFS)and overall survival(OS)of the two kinds of treatment mode in the same people.METHODS From 2014-01-01 to 2016-12-31 there were 62 people who met the entry criteria in clinical tumor center of People’s Hospital of Guangxi Zhuang Autonomous Region.These patients were randomly divided into concurrent chemoradiotherapy group(synchronous group)and sequential chemoradiotherapy group(sequential group)by random number table.In the synchronous group,the patients started concurrent chemoradiotherapy within 2to 4weeks after surgery,and the quantity of IMRT was(50-60)Gy/(5-6)W.On the first day of synchronous radiation,the patients were given500mg/m2 pemetrexed+75mg/m2 cisplatin with 21 days as one cycle.During the radiotherapy the patients got 2cycles of chemotherapy,then continued to get 2cycles to consolidate chemotherapy.In the sequential group,patients received4 cycles of adjuvant chemotherapy after surgery,and then IMRT.Chemotherapy scheme and IMRT dose were the same as the synchronization group.We observed the short-term toxicity and long-term prognosis of the patients.RESUITS The median DFS of synchronous group was 16.18(95%CI:14.44-17.92)months,sequential group was 15.43(95%CI:12.70-18.16)months(χ2=1.028,P=0.310).The median OS of synchronous group was 24.13(95%CI:19.20-29.07)months,sequential group was 23.90(95%CI:17.54-30.26)months(χ2=0.379,P=0.538).Two kinds of treatment had no statistical differences in survival benefit.There was no statistically significant difference between the two in the toxic reaction(χ2=1.060,P=0.303).CONCLU

关 键 词：肺腺癌 同步放化疗 序贯放化疗 治疗毒性 预后 

分 类 号：R734.2[医药卫生—肿瘤]