TP方案时辰化疗治疗晚期非小细胞肺癌的临床观察

目的评价TP方案时辰化疗治疗晚期非小细胞肺癌的疗效和安全性。方法紫杉醇135mg/m2＋生理盐水250ml,第1天,03：00～05：00静脉输注,其中高峰输注时间03：30～04：30,输注速度150ml/h,其余时间输注速度100ml/h;顺铂80mg/m2＋生理盐水500m第2天,15：30～16：30静脉输注,其中高峰输注时间15：30～16：30,输注速度300ml/h,其余时间输注速度为200ml/h;每位患者至少接受2个疗程化疗。结果53例非小细胞肺癌（NSCLC）完全缓解1例,部分缓解16例,稳定25例,进展11例,有效率为32.1%（17/53）,临床控制率为79.2%（42/53）。化疗后Karnofsky评分显著提高（P=0.032）。生活质量改善率为41.5%,功能状态改善率为67.9%,临床症状改善率为81.1%。全组无疾病进展时间4.1个月（95%CI,2.9～6.9）,中位生存时间7.8个月,一年生存率为38.3%（18/47）。骨髓抑制是主要的毒副作用,第1个疗程后粒细胞降低发生率37.2%（20/54）,但在第2个疗程加用粒细胞集（G-CSF）后降至12.1%（11/91）,3或4度粒细胞减少分别发生在9.3%（5/54）和2.2%（2/91）的患者中。腹泻和神经病变通常是轻度的,经对症处理可缓解。结论TP方案时辰化疗治疗晚期非小细胞肺癌疗效确切,可以改善生活质量,不良反应可以耐受,安全性高,可在临床上推广。

A clinical observation on chrono-chemotherapy of paclitaxol puls cisplatin for advanced non-small cell lung cancer

Objective To evaluate the efficacy and safety of paclitaxol plus cisplatin in the chronochemotherapy for advanced non-small cell lung cancer. Methods Fifty-three advanced non-small cell lung cancer received：Paclitaxol 135 mg/m2 in norma saline 250 ml iv drip from 3 am to 5 am （24-hour time-scale）in first day 1. Peak infusion time was at 4 ： 30am, infusion speed was 150 mL/h, holding infusion speed of other infusion time was 100 ml/h. DDP 80mg/m^2 in normal saline 500 ml iv drip from 3 pm to 5pm （24-hour time-scale ） day 2. Peak in fusion time was from 3：30pm to 4：30pm,infusion speed was 300 ml/h, holding infusion speed of other infusion time was 200 ml/h. The schedule was repeated every 21 days. Each patient at least had received 2 course of chrono-chemotherapy. Results One patient had complete response and sixteen patients partial complete. Twenty five patients had stable disease and Eleven patients had progressive disease. The overall response rate was 32. 1% ,disease control rate was 79.2 %. Time to progress was 4. 1 months （95% CI , 2. 9 -6. 9） , the median survival duration was 7.8 months , the 1 -year survival was 38.3 % Myelosuppression was the principal toxicity , granulocytopenia occurred in 37. 2 % （20/54）of patients after the first course , but decreased to 12. 1% （ 11/91 ） during the second course after introduction of G-CSF. Grade 3 or 4 granulocytopenia occurred in 9.3 % （5/54） and 2. 2 % （2/91）of patients. Diarrhea and neuropathy were generally mild ,which were manageable and reversible. Conclusion ChroMo-chemotherapy of paclitaxol plus cisplatin offers a new treatment option providing meaningful tumor control and symptom relief and well-tolerated side effects for advanced nonsmall cell lung cancer.