化、放同步治疗ⅢA/ⅢB期非小细胞肺癌的初步临床研究  

Randomized trial of hyperfractionated plus accelerated hyperfractionated radiation therapy with or without concomitant chemotherapy for stage ⅢA/ⅢB non-small-cell lung cancer:A preliminary result

作　　者：陆建伟[1] 王德镇[2] 陈嘉[1] 黄克伟[2] 何侠[2] 冯继锋[1] 

机构地区：[1]江苏省肿瘤防治研究所内科,南京210009 [2]江苏省肿瘤防治研究所放疗科,南京210009

出　　处：《中国肺癌杂志》2002年第6期423-426,共4页Chinese Journal of Lung Cancer

基　　金：江苏省科技厅应用基础项目 (BJ990 65)资助

摘　　要：目的　评价化、放同步治疗与单纯放射治疗ⅢA/ⅢB期非小细胞肺癌 (NSCLC)的疗效及毒副反应。方法　 5 6例ⅢA/ⅢB期NSCLC患者被随机分成同步放化疗组 (同步组 )和单纯放疗组 (单放组 ) ,单放组为原发灶和区域淋巴结前程超分割照射 ,每次 1.2Gy ,每天 2次 ,总量 45 .6Gy ;后程加速超分割照射 ,每次1.6Gy ,每天 2次 ,肿瘤灶总量为 68Gy。同步组在放疗同时给予足叶乙甙 5 0mg/m2 ,顺铂 2 0mg/m2 ,第 1～ 3、15～ 17、2 9～ 3 1天。结果　同步组有效率为 78.6% (2 2 /2 8) ,其中完全缓解 (CR) 10例 ,部分缓解 (PR) 12例。单放组有效率为 3 9.3 % (11/2 8) ,均为PR。同步组的有效率明显高于单放组 (P =0 .0 0 3 )。同步组和单放组的中位生存时间分别为 16和 13个月 (P =0 .0 0 0 3 )。同步组的远处转移率 (5 7.1% )明显低于单放组 (85 .7% ) (P =0 .0 18)。同步组Ⅲ～Ⅳ度放射性食管炎、中性粒细胞减少发生率分别为 3 9.3 % (11/2 8)、17.9% (5 /2 8) ,高于单放组的 17.9% (5 /2 8)和 3 .6% (1/2 8) ,但均无统计学差异 (P =0 .0 76和 0 .0 84)。结论　化、放同步治疗是ⅢA/ⅢB期非小细胞肺癌安全有效的治疗手段 ,值得进一步临床研究。Objective To investigate the efficacy of combined hyperfractionated radiation therapy (HFX RT) plus accelerated HFX RT and concomitant chemotherapy (CHT) in stage ⅢA or ⅢB non small cell lung cancer (NSCLC) compared with HFX RT alone. Methods From August 1998 to December 2001, 56 patients with NSCLC were randomized into the following groups: HFX RT alone group (group Ⅰ, n=28), HFX RT with 1.2 Gy twice daily to a total dose of 45.6 Gy, followed by accelerated HFX RT with 1.6 Gy twice daily, the total planned radiation dose was 68.0 Gy in tumour; HFX RT/CHT concomitant group (group Ⅱ, n=28), same RT with CHT consisting of 20 mg/m 2 of cisplatin (DDP) on days 1 to 3 and 50 mg/m 2 of etoposide (VP 16) on days 1 to 3, repeated every two weeks during the RT course. Results The overall response rate was 78.6% in group Ⅱ, including 10 patients with complete response and 12 with partial response; 39.3% in group Ⅰ, including 11 patients with partial response. Group Ⅱ had a higher overall response rate compared to Group Ⅰ (P=0.003). The median survival time was 16 months for group Ⅱ, 13 months for group Ⅰ. There was a significant difference in the median survival time between two groups (P= 0.000 3 ). Group Ⅱ (57.1%) had a lower distant metastasis rate compared with group Ⅰ (85.7%) (P= 0.018 ). Patients in group Ⅱ showed a higher incidence of acute and/or late high grade toxicity (hematologic toxicity, esophagitis, late lung toxicity) compared with group Ⅰ patients, but no significant difference was observed between the two groups. Conclusion The HFX RT plus accelerated HFX RT and concomitant PDD/VP 16 CHT is tolerable and substantially increases the response rate and prolongs survival in ⅢA/ⅢB NSCLC patients.

关 键 词：ⅢA/ⅢB期非小细胞肺癌 非小细胞肺癌 药物治疗 放射疗法 同步治疗 肺肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]