中国肿瘤临床与康复

目的评价新辅助化疗联合同步化、放疗治疗Ⅲ期非小细胞肺癌(NSCLC)的疗效。方法105例经病理或细胞学证实的Ⅲ期NSCLC患者,随机分为两组。53例新辅助化疗联合同步化、放疗(同步化放组),先使用NP方案化疗2疗程,长春瑞滨(NVB)25mg/m2,静脉注射,第1、8天;顺铂(DDP)25mg/m2,静脉滴注,第13天;化疗结束后2周开始用NP方案同步化、放疗,放疗为常规分割,每日1次,每次1.8Gy,每周5次。原发灶及淋巴结受累区59.464.8Gy/3336f/4549d,淋巴引流区50.4Gy/28f/38d。放疗结束再用NP方案化疗13疗程,共化疗46疗程。52例放疗后辅助化疗(序贯放化组),放疗、化疗方案与同步化放组相同,化疗46疗程。结果同步化放组、序贯放化组完全缓解率、部分缓解率分别为24.5%(13/53)、15.4%(8/52)和71.7%(38/53)、71.1%(37/52),P>0.05。中位生存期分别为24个月(95%CI19.228.8)和21个月(95%CI17.524.5)。1,2,3年生存率分别为84.9%(45/53)和71.2%(37/52)、49.1%(26/53)和30.8%(16/52)、20.8%(11/53)和9.6%(5/52),1,2,3年生存率差异有显著性(P<0.05)。同步化放组和序贯放化组的毒副反应发生情况相比较,差异无显著性(P>0.05)。结论NP方案新辅助化疗联合同步化、放疗治疗Ⅲ期非小细胞肺癌,1,2,3年生存率优于序贯放化组,毒性可耐受。

Objective To evaluate the efficacy of neo-chemotherapy plus concurrent chemoradiation therapy in treatment of stage-Ⅲ non-small cell lung cancer (NSCLC).Methods From January 2001 to December 2003, 105 cases with stage-Ⅲ NSCLC were randomly divided into two groups: fifty-three cases received two cycles of neo-chemotherapy plus concurrent chemoradiation therapy (group A);fifty-two cases received sequential radiotherapy combined with chemotherapy (group B).The chemotherapy regimen was vinorelbine 25 mg/m 2 , d1 and d8,cisplatin 25 mg/m 2 ,d1-d3.The radiotherapy method was conventional fractionation with 1.8 Gy/fraction, five fractions per week, with the total dose of 59.4-64.8 Gy/33-36f in 45-49d to areas of primary focus and lymph node involvement and 50.4 Gy/28f in 38 d to regional lymphatic drainage area.Results The complete response rate in group A and group B was 24.5% (13/53) and 15.4% (8/52) and the partial response rate in group A and group B was 71.7% (38/53 ) and 71.1% (37/52) respectively,P>0.05.The median survival time in group A and group B was 24.0 months (95%CI, 19.2-28.8) and 21.0 months (95%CI,17.5-24.5)and 1-,2,-3-year survival rates for group A and group B were 84.9% (45/53) and 71.2% (37/52),49.1% (26/53) and 30.8% (16/52),20.8% (11/53 ) and 9.6% (5/52) respectively.The difference of 1-,2-,3-year survival rates was statistically significant(P< 0.05 ).Neutropenia,radiation esophagitis and radiation pneumonitis in the 2 groups were similar.Conclusion The result shows that neo-chemotherapy plus concurrent chemoradiation therapy for stage-Ⅲ NSCLC is acceptable and the 1-,2-,3-year survival rates are superior to those after sequential radiotherapy combined with chemotherapy.