EGFR-TKI同步放疗治疗不可手术的EGFR突变型Ⅲ期非小细胞肺腺癌的临床观察  

Study of EGFR-TKI Concurrent with Radiotherapy for Unresectable Stage Ⅲ Non-small Cell Lung Cancer with EGFR Mutations

作　　者：刘新福 尹婵 张辉 肖集文[2] 卢奕宇 LIU Xinfu;YIN Chan;ZHANG Hui;XIAO Jiwen;LU Yiyu(Department of Oncology,Shaoyang Central Hospital,Shaoyang,Hunan,422000,China;Department of Oncology,the First People’s Hospital of Huaihua,Huaihua,Hunan,418000,China;Department of Oncology,Nanhai Hospital Affiliated to Southern Medical University,Foshan,Guangdong,528000,China)

机构地区：[1]邵阳市中心医院肿瘤中心,湖南邵阳422000 [2]怀化市第一人民医院肿瘤中心,湖南怀化418000 [3]南方医科大学附属南海医院放疗科,广东佛山528000

出　　处：《肿瘤药学》2019年第4期636-640,657,共6页Anti-Tumor Pharmacy

基　　金：湖南省卫计委基金项目（20180610）

摘　　要：目的观察表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)同步放疗治疗不可手术的EGFR突变型III期非小细胞肺腺癌的临床疗效及安全性。方法回顾性分析2014年1月-2016年1月邵阳市中心医院及兄弟医院收治的不可手术的EGFR突变型III期非小细胞肺腺癌患者58例,根据治疗方案分为EGFR-TKI组(观察组)和培美曲塞+顺铂组(对照组),各29例。两组患者均同步行三维适形放疗,比较两组患者的临床疗效、无疾病进展时间(PFS)及治疗期间的毒副反应。结果观察组CR 6例、PR 17例、SD 4例、PD 2例,总有效率为79.31%(23/29),对照组CR 3例、PR 12例、SD 10例、PD 4例,总有效率为51.72%(15/29),观察组近期疗效显著优于对照组(P<0.05)。观察组患者PFS(12.6个月)显著长于对照组(9.1个月)(P<0.01)。两组患者肝功能损害、放射性食管炎、放射性肺炎的发生率无显著差异(P>0.05);观察组患者胃肠道反应(恶心呕吐)和骨髓抑制(中性粒细胞减少、血小板减少)的发生率显著低于对照组(P<0.05);观察组患者皮疹和腹泻的发生率显著高于对照组(P<0.01)。结论EGFR-TKI同步放疗治疗不可手术的EGFR突变型III期非小细胞肺腺癌是一种安全、有效的治疗模式。Objective To evaluate the safety profile and efficacy of epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKI)concurrent with radiotherapy in patients with unresectable stageⅢnon-small cell lung adenocarcinoma and EGFR mutations.Methods A retrospective analysis was performed on the medical records of 58 cases of non-resectable stageⅢnon-small cell lung adenocarcinoma patients with EGFR mutations.They were divided into two groups according to different treating regimens.Twenty-nine patients in observation group received TKI concurrent with radiotherapy,and the other 29 patients in control group were treated with the pemetrexed and cisplatin concurrent with radiotherapy.Clinical effect,median progression free survival(PFS),incidence of toxic and side effects during the treatment were compared between the two groups.Results Among the 58 cases,treatment response was as follows:complete response(CR)in 6 cases,partial response(PR)in 17 cases,stable disease(SD)in 4 cases,and progressive disease(PD)in 2 cases in the observation group;CR in 3 cases,PR in 12 cases,SD in 10 cases,and PD in 4 cases in the control group.The total effective rate was respectively 79.31%(23/29)and 51.72%(15/29)in the observation group and the control group(χ2=4.884,P=0.027).Patients in the observation group had a longer median PFS than those in the control group(PFS:12.6 months vs.9.1 months,P<0.01).No statistically significant differences were found in the incidence of liver damage,esophagitis or pneumonitis of radioactivity between the two groups(P>0.05).However,the incidence of bone marrow inhibition,nausea and vomiting of the observation group was statistically lower than that of the control group(P<0.05),yet the incidence of diarrhea and skin rashes of the observation group was statistically higher than that of the control group(P<0.01).Conclusion TKI concomitant radiotherapy was effective and safe as first-line regimen for patients with unresectable stage III non-small cell lung adenocarcinoma with EGFR mutations.

关 键 词：非小细胞肺腺癌 EGFR TKI 放化疗 

分 类 号：R734.2[医药卫生—肿瘤]