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  

Clinical analysis of concurrent versus sequential chemoradiotherapy for 85 medically inoperable patients with locally advanced non-small-cell lung cancer

作　　者：姜勇[1] 崔林[1] 何学军[1] 吴兴军[1] 周向荣[1] 刘建军[1] 陈高阳[1] 刘兴祥[1] 李阳[1] 

机构地区：[1]泰州市第二人民医院肿瘤科,江苏泰州225500

出　　处：《现代肿瘤医学》2017年第1期56-59,共4页Journal of Modern Oncology

摘　　要：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。Objective： To evaluate the therapeutic efficacy and treatment- related toxicity of concurrent versus sequential chemoradiotherapy for medically inoperable patients with locally advanced non- small- cell lung cancer（ NSCLC）. Methods： Clinical data of 85 patients with stage III NSCLC who received concurrent or sequential chemoradiotherapy as initial treatment between July 2011 and December 2013 was reviewed. 45 patients who received concurrent chemoradiotherapy were included in group A,40 patients who received sequential chemoradiotherapy were enrolled in group B. Three- dimensional conformal radiotherapy（ 3D- CRT） was applied to all patients. Total radiotherapy doses of 60 Gy in 30 fractions were delivered. Paclitaxel plus cisplatin was administered as concurrent chemotherapy in group A,as sequential chemotherapy in group B. The efficacy,toxicity,1-,and 2- year survival rate of concurrent chemoradiotherapy were retrospectively analyzed. Results： All the 85 patients could be evaluated,the follow- up rate was 100%. The response rates for group A and group B were 73. 3% and 50. 0%（ P〈0. 05）. 1- year local control rates were 51. 1% and 30. 0%（ P〈0. 05）. 1- year survival rate were 62. 2% and 42. 5%（ P〉0. 05）,2- year survival rates were 37. 8% and 17. 5%（ P〈0. 05）. The rates of grade≥Ⅲ radiation pneumonitis,esophagitis and hematologic toxicity in group A were 6. 7%,11. 1% and 28. 9%,respectively,group B were 5. 0%,10. 0% and 27. 5%.Toxic effects in two groups were tolerable for all of the patients. Conclusion： Concurrent chemoradiotherapy is effective and well tolerated for locally advanced NSCLC,it is better than sequential chemoradiotherapy as a standard therapeutic approach for patients with unresectable locally advanced NSCLC.

关 键 词：非小细胞肺癌 同步放化疗 三维适形放疗 紫杉醇 顺铂 

分 类 号：R734.2[医药卫生—肿瘤]