培美曲塞和卡铂对比紫杉醇和卡铂同期放化疗治疗局部晚期非小细胞肺癌的临床研究

目的探讨培美曲塞和卡铂对比紫杉醇和卡铂方案联合同期放化疗治疗局部晚期非小细胞肺癌的疗效和毒副反应。方法60例Ⅲ期非小细胞肺癌患者（ⅢA期39例，ⅢB期21例）随机分为两组，一组接受培美曲塞500mg／㎡，d1，卡铂AUC5，d1，21天重复；另一组接受紫杉醇150mg／m。，dl，卡铂AUC5，d1，21天重复。两组患者化疗期间同时接受适形调强放疗，总剂量60。70Gy，同步放化疗结束后2—4周继续给予原化疗方案巩固2～3周期。结果培美曲赛联合卡铂组与紫杉醇联合卡铂组的疾病有效率分别为44．83％和29．03％，疾病控制率分别为79．31％和67．74％，差异有统计学意义（P〈0．05）。培美曲赛组不良反应少见，两组的中位无进展生存分别为12．5个月和9．9个月，1年生存率分别为58．62％和48．39％，差异有统计学意义（P〈0．05）。结论培美曲赛联合卡铂可作为Ⅲ期非小细胞肺癌患者同期放化疗期间的优选化疗方案，毒性可耐受，疾病控制率及生存率较紫杉醇联合卡铂方案明显提高。

Clinical comparison study on pemetrexed combined with carboplatin versus paclitaxel combined with carboplatin asconcurrent chemoradiotherapy in locally advanced non-small cell lung cancer

Objective To observe the effect and clinical toxicity of pemetrexed combined with carboplatin versus paclitaxel combined with carboplatin with concurrent chemoradiotherapy in locally advanced non-small cell lung cancer （NSCLC）. Methods Total of 60 patients stage Ⅲ NSCLC （ⅢA 39 patients, IIIB 21 patients） were randomly assigned into two groups. Pemetrexed combined with carboplatin group： accepted pemetrexed 500 mg/㎡, d1, carboplatin AUC 5, dl, once every 21 days. Paclitaxel combined with carboplmin group： paclitaxel 150 mg/m2, dl, carboplatin AUC 5, dl, once every 21 days. Two groups both accepted 3-D conformal radiation therapy （3D-CRT） during chemotherapy. The total dose was 60 - 70 Gy. After radiation therapy, the patients were accepted 2 - 3 cycles of chemotherapy. Results The efficacy of pemetrexed combined with carboplatin and paclitaxel combined withcarboplatin were 44.83% and 29.03% respectively. The disease control rates of two groups were 79.31% and 67.74% respectively. The differences were statistically significant （P〈0.05）. The adverse reactions of pemetrexed group were rare. Two groups of median progression-free survival were 12.5 and 9.9 months respectively. 1 year overall survival was 58.62% and 48.39% respectively. The differences were also significant （P〈0.05） . Conclusion Pemetrexed combined with carboplatin can be used as stage III NSCLC patients treated with concurrent chemoradiation regimens during optimization. Toxicity was tolerable. Pemetrexed group was better than paclitaxel group in disease control rates and survival.