吉西他滨与紫杉醇联合奈达铂治疗晚期非小细胞肺癌的疗效及毒性反应观察

目的观察吉西他滨联合奈达铂化疗方案对照紫杉醇联合奈达铂化疗方案治疗晚期非小细胞肺癌的近期疗效及毒性反应。方法经组织病理学确诊为非小细胞肺癌,TNM分期为晚期的患者,共133例,按单纯随机法分为2组:吉西他滨组67例,采用吉西他滨(Gem)1 000 mg/m2D1、D8+奈达铂(NDP)80 mg/m2D1(或D8)方案,紫杉醇组66例,采用紫杉醇(PTX)175 mg/m2D1+奈达铂80 mg/m2D1方案,21 d为1个周期。于第2周期末评定靶病灶变化,对靶病灶无变化或增大者转2线方案化疗。对靶病灶缩小者继续原方案化疗,于第4周期末进行疗效评价,并对2种方案的毒性反应比较。结果全部完成4个周期者,吉西他滨组55例,治疗有效率54.55%,部分缓解的30例中鳞癌占27例;紫杉醇组51例,治疗有效率50.98%,部分缓解的26例中腺癌占24例。血液毒性在吉西他滨组化疗各周期均有不同程度白细胞降低,以Ⅰ、Ⅱ为主。第4周期末,发生Ⅲ、Ⅳ度骨髓抑制患者中,2组间白细胞和血小板受抑制无差异(P>0.05);而血红蛋白下降,吉西他滨组高于紫杉醇组,2组间差异有统计学意义(P<0.05);非血液毒性中便秘在吉西他滨组高于紫杉醇组(P<0.05),脱发、肌痛、周围神经损害紫杉醇组高于吉西他滨组(P<0.05),其余症状在2组间无差异(P>0.05);2组患者均无化疗相关性死亡。结论 2种化疗方案,近期疗效无差异。从组织类型亚型观察,鳞癌选择吉西他滨,非鳞癌选择紫杉醇更适合。2组患者的毒性反应均能耐受,吉西他滨组患者毒性反应的主观症状较少,因而耐受性及依从性更好。

Efficiency and toxic reaction of nedaplatin combined with gemcitabine or paclitaxel in treatment of advanced non-small cell lung cancer: report of 133 cases

Objective To determine the efficiency of gemcitabine combined with nedaplatin chemotherapy or paclitaxel combined with nedaplatin chemotherapy regimen in treatment of advanced non-small cell lung cancer and their toxic reaction.Methods A total of 133 patients with histopathological diagnosis of non-small cell lung cancer,and TNM staging of advanced who hospitalized in our hospital during January 2010 to September 2011 were prospectively enrolled,and then randomly,divided into 2 matched groups,gemcitabine group(n=67) and paclitaxel group(n=66).The patients from the former group were treated with a regimen of gemcitabine(Gem) 1 000 mg/m2 D1,D8+nedaplatin(NDP) 80 mg/m2 D1(or D8) scheme.While,those of the later group received a treatment of paclitaxel(PTX) 175 mg/m2 D1+80mg/m2 D1 nedaplatin regimen,for a period of 21 d.In the end of second cycle,the change of target tumor mass was finally evaluated.For the mass without change or increased in size,second-line chemotherapy was carried out.For the target mass was decreased in size,former chemotherapy was continued.The final efficiency of the 2 regimens was assessed in the the end of fourth cycle,and their toxicity reactions were compared.Results There were 55 patients of gemcitabine group who completed 4 cycles of chemotherapy,and 30 of them achieved complete(CR) or partial remission(PR),including 27 cases of squamous cell carcinoma.The treatment efficiency was 54.55%.Fifty-one patients of paclitaxel group completed the 4 cycles,with 26 cases achieving CR or PR,including 26 cases of adenocarcinoma,with a efficiency of 50.98%.Hematologic toxicity of gemcitabine chemotherapy displayed the leukocytes was decreased at different degrees,mainly Ⅰ to Ⅱ.But no significant difference was found in the white blood cells and platelets for the patients with Ⅲ and Ⅳ bone marrow depression patients between the 2 groups(P>0.05).But hemoglobin was decreased,with gemcitabine group significantly higher than paclitaxel group(P<0.05).There were more constipation found in the gemcitabine group than paclitaxel group(P<0.05),but more hair loss,peripheral nerve damage,and myalgia in paclitaxel group than gemcitabine group(P<0.05).No difference was observed in other symptoms between the 2 groups(P>0.05).Also no chemotherapy related death was seen in the 2 groups.Conclusion There is no significant difference in short-term efficiency of the 2 chemotherapy regimens.Gemcitabine may be suitable to squamous cell carcinoma,while paclitaxel to non squamous cell carcinoma.Toxic reactions are tolerant to the patients of 2 groups.Gemcitabine groups have less subjective symptoms,so have better tolerance and compliance.