培美曲塞联合顺铂在局部晚期肺腺癌同步放化疗中的临床研究

目的 观察培美曲塞联合顺铂同步放化疗治疗局部晚期肺腺癌的近期疗效和急性毒副反应.方法 18例经病理确诊的局部晚期肺腺癌患者（ⅢA或ⅢB）接受同步放化疗,放疗均采用IMRT计划,照射剂量60～70 y,1.8～2 Gy/次,5次/周.同步化疗方案为培美曲塞（500 mg/m2 d1）,顺铂（75 mg/m2d1）.3周重复,共2个周期,与放疗同期进行.部分患者接受1～2周期的新辅助化疗,化疗方案同同步化疗方案.结果 完全缓解（CR）3例,部分缓解（PR） 12例,稳定（SD）2例,进展（PD）1例,客观有效率（CR＋PR）为83.4％,疾病控制率（CR＋PR＋SD）为94.5％.主要毒副反应是放射性食管炎、骨髓抑制和轻度胃肠道反应,经对症支持治疗患者均能耐受.结论 培美曲塞联合顺铂同步放化疗治疗局部晚期肺腺癌,近期疗效肯定,耐受性良好,远期疗效和晚期并发症有待进一步观察.

Clinical study of pemetrexed combined with cisplatin concurrent chemoradiotherapy in locally advanced adenocarcinoma of lung

Objective To evaluate short-term effect and acute adverse reactions of pemetrexed combined with cisplatin concurrent chemoradiotherapy in locally advanced adenocarcinoma of lung.Methods 18 patients with locally advanced adenocarcinoma of lung received concurrent chemoradiotherapy（pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 were administrated to patients on the first day of every 3 weeks for 2 cycles）,part of the patients were administrated neoadjuvant chemotherapy for 1-2 cycles.Radiotherapy adopted IMRT with a total of 60-70 Gy,1.8-2 Gy/f,5 times per week.Results There were 3 cases of CR,12 cases of PR,2 cases of SD,1 case of PD.The overall response rate （CR ＋ PR） was 83.4％ and the clinical benefiting rate （CR ＋ PR ＋ SD） was 94.5％.The main adverse effects were radioactive esophagitis,bonemarrow suppression and mild gastrointestinal toxicit,tolerated by patients with support treatment.Conclusions Pemetrexed combined with cisplatin concurrent chemoradiotherapy in locally advanced adenocarcinoma of lung has good short-term effect,safety and tolerability.Long-term survival and late complications need further observation.