实用肿瘤学杂志 ›› 2009, Vol. 23 ›› Issue (4): 319-322.doi: 10.3969/j.issn.1002-3070.2009.04.006

• 论著 • 上一篇    下一篇

同期减量放化疗与序贯放化疗治疗III期非小细胞肺癌的临床试验

郝春成, 葛晓峰, 阎红娇, 孙长清   

  1. 哈尔滨医科大学附属肿瘤医院放疗二科(哈尔滨 150081)
  • 收稿日期:2009-03-31 出版日期:2009-08-20 发布日期:2012-02-21
  • 作者简介:郝春成, 男, (1980-), 硕士研究生, 住院医师, 从事肿瘤放射治疗的临床和基础研究

Clinical trial of concurrent low-dose chemotherapy plus radiation vs sequential chemoradiotherapy for unresectable stage III non-small cell lung cancer

HAO Chuncheng, GE Xiaofeng, YAN Hongjiao, SUN Changqing.   

  1. Department of Radiotherapy, The Affiliated Tumour Hospital of Harbin Medical University, Harbin 150081
  • Received:2009-03-31 Online:2009-08-20 Published:2012-02-21

摘要: 目的探讨和比较同期减量放化疗与序贯放化疗治疗不能手术的III期NSCLC的毒副反应和近期疗效。方法 病理证实为IIIa, IIIb期(非恶性胸腔积液)不能手术的初治NSCLC患者80例随机分为2组。同期放化疗组(A):2周期紫杉醇(减半量)+顺铂(TP)方案化疗, 于放疗第一天同期进行。放疗用三维适形放疗, 放疗至总量60Gy-70Gy。同期放化疗结束后继续TP(全量)方案巩固化疗3周期。序贯放化疗组(B):入组后先行放疗, 放疗方案同A组, 放疗结束后行TP(全量)方案化疗4-5周期。采用WHO近期疗效评价标准和放化疗毒副反应分级标准进行评定。结果 A组近期有效率为80.0%, B组为57.5%(χ2=4.71, P<0.05), A组III, IV度急性放射性食管炎, 白细胞减少, 恶心呕吐和皮肤反应发生率分别为47.5%, 42.5%, 52.5%和57.5%明显高于B组的25.0%, 17.5%, 30.0%和17.5%(P<0.05);A, B组III, IV度急性放射性肺炎, 脱发发生率分别为32.5%, 7.5%和20.0%, 27.5%(P>0.05)。结论 TP方案减量同期放化疗治疗不能手术的III期NSCLC, 近期疗效较序贯放化疗组高, 副反应经积极对症治疗可以耐受。

Abstract: Objective Evaluate the early response and toxicity of concurrent chemoradiotherapy.Methods Eighty unresectable stage IIIa-IIIb NSCLC patients pathologically proved were randomly divided into 2 groups.Group A:patients were treated with concurrent chemotherapy of paclitaxel(100mg/m2, on day2.)and cisplatin(30mg/m2, on days 2-6)(TP regimen)plus 3-dimensional conformal radiotherapy.The total dose was 60Gy-70Gy.After the radiation, 3 cycles of TP regimen were performed, but the dose of paclitaxel was 200mg/m2.Group B:patients received sequential chemoradiotherapy.First radiation was performed as same as group A.Then chemotherapy of TP(paclitaxel 200mg/m2, on day 2, DDP 30mg/m2, on days 2-6)was followed for 4-5 cycles.Results The overall response rate in concurrent and sequential groups was 80.0%and 57.5% respectively(χ2 =4.71, P<0.05).Incidences of grade III-Ⅳ acute radiation esophagitis, leukopenia, nausea/vomiting and skin reaction were 47.5%, 42.5%, 52.5% and 57.5% in group A, and 25.0%, 17.5%, 30.0% and 17.5%in group B respectively(P<0.05).Incidences of grade III-Ⅳ acute radiation pneumonitis and lose hair rate was 32.5%, 7.5% in group A and 20.0%, 27.5%in group B respectively(P>0.1).Conclusion Concurrent chemoradiotherapy is well tolerated in most unresectable stage IIIa-IIIb NSCLC patients.Its early response is better than sequential chemoradiotherapy.

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