同步放化疗与序贯放化疗治疗67例局部晚期非小细胞肺癌的疗效比较

[目的]探讨同步放化疗及序贯放化疗治疗局部晚期非小细胞肺癌（NSCLC）的疗效及不良反应。[方法]67例局部晚期NSCLC患者分为同步放化疗组（35例）及序贯放化疗组（32例）。同步放化疗组采用紫杉醇40mg/m2,卡铂AUC=2,d1;3DCRT与化疗同时开始,每周1次。序贯放化疗组先行2个周期全身化疗：紫杉醇150mg/m2,卡铂AUC=6,d1,21d为1个周期;第42d开始行3DCRT。[结果]同步放化疗组及序贯放化疗组有效率分别为77%及56%,1年生存率分别为76%和66%,2年生存率分别为39%和32%,差异均无统计学意义（P〉0.05）。两组不良反应差异无显著性（P〉0.05）。同步放化疗组、序贯放化疗组局部复发率分别为20%（7/35）和31%（10/32）,差异有统计学意义（χ2=4.521,P=0.033）。[结论]同步放化疗治疗局部晚期NSCLC疗效较好,但有增加不良反应的可能。     

局部晚期非小细胞肺癌同期放化疗和序贯放化疗的临床疗效比较

目的：比较局部晚期非小细胞肺癌同期与序贯放化疗治疗局部晚期非小细胞肺癌（NSCLC）的疗效和不良反应。方法：58例Ⅲa期和Ⅲb期NSCLC患者随机分为两组。序贯组在化疗4个周期结束后行放疗。同期组于放疗开始第1,4,8,12周给予化疗。两组病例均采用三维立体适形放疗,GP方案（吉西他滨＋顺铂）化疗。结果：同期组和序贯组的有效率分别为75.9%和48.3%,两组比较差异有显著性（P〈0.05）。在疾病控制率方面,同期组为93.1%,序贯组为72.4%,两组比较有显著性差异（P〈0.05）。两组患者的血液学不良反应,同期组发生率为100.0%,序贯组为79.3%,两组间存在统计学差异（P〈0.05）。结论：同期组的近期疗效较序贯组存在明显优势。     

局部晚期非小细胞肺癌同期放化疗和序贯放化疗的临床疗效比较

目的:比较局部晚期非小细胞肺癌同期与序贯放化疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法:58例Ⅲa期和Ⅲb期NSCLC患者随机分为两组。序贯组在化疗4个周期结束后行放疗。同期组于放疗开始第1,4,8,12周给予化疗。两组病例均采用三维立体适形放疗,GP方案(吉西他滨+顺铂)化疗。结果:同期组和序贯组的有效率分别为75.9%和48.3%,两组比较差异有显著性(P<0.05)。在疾病控制率方面,同期组为93.1%,序贯组为72.4%,两组比较有显著性差异(P<0.05)。两组患者的血液学不良反应,同期组发生率为100.0%,序贯组为79.3%,两组间存在统计学差异(P<0.05)。结论:同期组的近期疗效较序贯组存在明显优势。     

局部晚期非小细胞肺癌同期放化疗加巩固化疗与序贯放化疗的疗效比较

目的探讨局部晚期非小细胞肺癌（NSCLC）同期放化疗加巩固化疗与序贯放化疗的近期和远期疗效及不良反应。方法选取2010年1月至2012年12月住院治疗的77例局部晚期非小细胞肺癌患者,随机分为同期加巩固组（37例）和序贯组（40例）。同期加巩固组患者在第1周、第5周分别给予依托泊苷＋顺铂（EP方案）化疗,之后给予单药多西他赛巩固化疗2～4个周期。序贯组患者先行多西他赛＋顺铂（TP方案）化疗2～4个周期,再行放射治疗或先放射治疗后给予TP方案化疗2～4个周期。放射治疗为常规普通放疗（总剂量60～66Gy,分30～33次,5～6周完成）。结果两组患者有效率分别为83.8%和55.0%,差异有统计学意义（P〈0.05）;两组患者的中位生存时间分别为18.0个月和15.0个月,1年生存率分别为75.4%和66.7%,2年生存率分别为49.2%和40.7%,差异有统计学意义（P〈0.05）。不良反应主要为骨髓抑制、放射性食管炎、放射性肺炎及胃肠反应。同期加巩固组患者的不良反应发生率明显高于序贯组,差异有统计学意义（P〈0.05）。结论同期加巩固化疗相比于传统的序贯放化疗,可以提高局部晚期非小细胞肺癌患者近期有效率,延长生存时间,但不良反应相应增加,尤其是骨髓抑制和放射性食管炎,临床应根据患者具体情况选择应用。     

放化疗联合治疗局部晚期鼻咽癌的临床观察

  目的  在局部晚期鼻咽癌根治性放疗联合紫杉醇、顺铂化疗中, 分析同步治疗与序贯治疗对治疗疗效的影响。  方法  144例局部晚期鼻咽癌病例进行随机分组, 同步治疗组: 放疗联合TP同步化疗; 序贯治疗组: 一疗程TP诱导化疗+根治性放疗+3疗程TP辅助化疗。放疗采用三维适形技术, 化疗采用紫杉醇联合顺铂方案。放疗及化疗方案联合治疗与同步治疗相同。  结果  全部病例至少随访2年, 同步治疗组与序贯治疗组: 局部控制率分别为81.2%与76.3%;远处转移率分别为9.7%与19.4%;2年无瘤生存率分别为76.4%与66.7%。  结论  研究表明局部晚期鼻咽癌接受同步放化疗, 无瘤生存率提高, 远处转移率降低; 不良反应与序贯治疗相比, 主要是放射性黏膜炎发生率和严重程度增加, 但经对症处理, 患者一般都能耐受。      

不能手术局部晚期非小细胞肺癌同步或序贯放化疗85例临床分析

目的：评价不能手术局部晚期非小细胞肺癌（ NSCLC）患者同步或序贯放化疗的疗效和不良反应。方法：2011年7月至2013年12月间初治接受同步或序贯放化疗的85例患者入组本研究,其中45例同步放化疗患者列入A组,40例序贯放化疗患者列入B组。A组采用放疗同步紫杉醇、顺铂化疗,B组采用单纯放疗,放疗结束后行紫杉醇、顺铂化疗。两组放疗方法相同,均为三维适型放疗,剂量60Gy/30f。对比两组治疗的疗效、不良反应和1、2年生存率。结果：85例患者均可评价疗效,随访率100%。A组与B组有效率分别为73.3%和50.0%（P﹤0.05）;1年局部控制率分别为51.1%和30.0%（P﹤0.05）;1年生存率分别为62.2%和42.5%（P﹥0.05）;2年生存率分别为37.8%和17.5%（P﹤0.05）。A组≥Ⅲ级放射性肺炎、放射性食管炎及Ⅲ~Ⅳ级骨髓抑制的发生率分别为6.7%、11.1%和28.9%,B组分别为5.0%、10.0%和27.5%。两组不良反应相似,均可耐受。结论：局部晚期NSCLC同步放化疗的疗效优于序贯放化疗,不良反应可耐受,同步放化疗是不能手术的局部晚期NSCLC标准治疗方法。     

调强放疗联合吉西他滨治疗局部晚期非小细胞肺癌近期效果分析

目的 观察调强放疗联合吉西他滨在局部晚期非小细胞肺癌（NSCLC）患者中的近期疗效。方法 回顾性分析局部晚期NSCLC患者45例临床资料。予吉西他滨加顺铂方案诱导化疗2个周期后,分为调强放疗序贯吉西他滨加顺铂方案化疗组和吉西他滨加顺铂方案单纯化疗组。结果 序贯组客观缓解率为65.2 %（15／23）,单独化疗组客观缓解率为31.8 %（7／22）,差异有统计学意义（P＜0.05）;序贯组和单纯化疗组1年生存率分别为66.4 %和45.0 %,两组间差异有统计学意义（P＜0.05）。结论 调强放疗序贯吉西他滨加顺铂方案化疗治疗局部晚期NSCLC较吉西他滨加顺铂方案化疗的近期疗效好,不良反应可以耐受。     

放疗联合同期化疗治疗Ⅲ期非小细胞肺癌的临床研究

为了评价放疗联合同期化疗对不能手术的Ⅲ期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的疗效,将81例患者随机分为2组同期放化疗组41例患者,在放疗的同时每周接受顺铂(DDP)30mg/m2的化疗,共用6周,于第1、8天接受长春瑞滨(NVB)25mg/m2的化疗,每3周1次;序贯放化疗组40例患者均接受NVB与DDP的诱导化疗2个疗程,然后放疗。两组放疗方法相同,每周10Gy,共60~70Gy。结果同期放化疗组和序贯放化疗组的总有效率分别为80.5%(33/41)和60.0%(24/40),差异有统计学意义,P=0.043;完全缓解率分别是19.5%(8/41)和12.5%(6/40),差异无统计学意义,P=0.591。中位生存时间分别为15.8和13.1个月,差异有统计学意义,P=0.032。主要的不良反应是放射性食管炎、放射性肺炎与骨髓抑制,差异有统计学意义,P=0.032。初步研究结果提示,放疗联合NVB与DDP的同期化疗延长了不能手术的Ⅲ期NSCLC的生存期。     

同步放化疗治疗中晚期非小细胞肺癌临床分析

目的观察同步放化疗治疗中晚期非小细胞肺癌（NSCLC）的疗效和毒副反应。方法入组不能手术的中晚期NSCLC 63例,随机分为两组。序贯组33例,化疗2周期后再行放疗;同步组30例,放化疗同时进行。化疗采用紫杉醇加顺铂方案,放疗剂量66.0-70.0 Gy。结果序贯组和同步组的总有效率分别为42.4%、70.0%,差异有统计学意义（P〈0.05）;序贯组与同步组的1、2、3年生存率以及中位生存时间分别为42.4%、23.1%、6.6%、11.0月和60.0%、35.1%、30.1%、18.0月,差异均有统计学意义（P〈0.05）;同步治疗的毒副反应多于序贯治疗,但两组均无Ⅳ级毒副反应发生。结论同步放化疗治疗NSCLC的疗效优于序贯治疗;其毒副反应虽有所增加,但均可耐受。     

NVB加DDP联合放疗同步与序贯治疗晚期NSCLC的临床研究

目的 :评价和比较NVB和放疗同步与序贯治疗局部晚期NSCLC近期疗效和患者耐受性。方法 :41例晚期NSCLC患者随机分入同步治疗组和序贯治疗组。同步组每周前 3日放疗前予NVB加DDP化疗 ,共 6周。序贯组予 2周期NP方案 (NVB 2 5mg/m2 ,d1、8,DDP5 0mg ,d1- 3)化疗后常规放疗。结果 :同步组和序贯组总有效率分别为 6 6 7%和 5 0 %,差异无显著性。同步组局部控制率高于序贯组 (P <0 0 5 )。两组不良反应无显著性差异。结论 :NVB加DDP和放疗同步治疗晚期NSCLC局部控制率高于序贯治疗 ,总有效率及不良反应两组相近。     

临床N2期非小细胞肺癌治疗进展

临床N2期非小细胞肺癌(NSCLC)最佳治疗方案仍未确定,根治性同期化放疗为目前推荐的标准治疗方案.诱导化疗后同期化放疗并不优于标准的同期化放疗;术前新辅助化疗并未能提高总生存率,但新辅助同期化放疗后肺叶手术切除能提高总生存率.同期化放疗后继续巩固化疗作用仍有争论;吉非替尼或厄洛替尼维持治疗也未能带来生存受益.预防性脑照射仅能降低脑转移率,并未能提高总生存率.     

TPF方案诱导化疗联合替吉奥同步放疗治疗局部晚期鼻咽癌的临床观察

目的 探讨TPF方案诱导化疗联合替吉奥（S-1）同步调强适形放疗（IMRT）治疗局部晚期鼻咽癌的临床疗效及安全性。方法采用诱导化疗联合S-1同步IMRT治疗38例局部晚期鼻咽癌患者,诱导化疗采用TPF方案：紫杉醇（PTX）135 mg/m2,静滴,d1;顺铂（DDP）80 mg/m2静滴,d1;氟尿嘧啶（5 FU）750 mg/（m2&#8226;d）,持续静脉泵入,d1～d5（120 h）。21天为1个周期,共行2个周期。同步化疗采用替吉奥（S-1）单药,40 mg/m2,口服,2次/日,d1～d14。21天为1个周期,共行2～3个周期。同步放疗PGTVnx（69.96～73.92）Gy/33 f,PGTVnd 69.96 Gy/33 f,PTV1 60.06 Gy/33 f,PTV2 50.96 Gy/28 f,PTVnd 50.96 Gy/28 f,1次/日,5次/周。结果 38例患者均完成2个周期诱导化疗和2～3个周期同步放化疗。所有患者治疗结束评价即刻疗效,获CR 29例,PR 8例,SD 1例,有效率（RR）为974%。治疗结束3个月评价近期疗效,获CR 33例,PR 5例,RR为100%。诱导化疗的主要毒副反应为恶心、白细胞减少、血红蛋白减少。同步放化疗的主要毒副反应为口腔黏膜炎、放射野内皮炎、吞咽痛。其中3级口腔黏膜炎、放射野内皮炎、吞咽痛的发生率分别为7.9%、2.6%、2.6%,均无4、5级毒副反应。结论TPF方案诱导化疗同步替吉奥化疗联合IMRT治疗鼻咽癌,近期疗效好,且毒副反应较小,患者耐受性好。     

PGC方案诱导化疗后同步放化疗治疗Ⅲ~ⅣA期鼻咽癌的Ⅱ期单中心前瞻性临床研究

目的 评价脂质体紫杉醇、吉西他滨、卡铂三药联合的诱导化疗（PGC方案）序贯同步放化疗治疗中晚期鼻咽癌患者的疗效及不良反应。方法 对初治Ⅲ~ⅣA期33例鼻咽癌患者, 给予2周期PGC方案新辅助化疗,序贯同步放化疗。诱导化疗方案：脂质体紫杉醇135 mg/m2+吉西他滨1 000 mg/m2+卡铂,血药浓度-时间曲线下面积（area under the curve,AUC）取5,第一天给药,每三周一次。第7周开始调强放射治疗同步化疗,卡铂AUC=5, 每三周一次。结果 在PGC诱导化疗两周期后评价：7例（21%）完全缓解（CR）,21例（64%）部分缓解（PR）,4例（12%）稳定（SD）,1例（3%）进展（多发性肺转移）。放疗完成3月后评价,28（85%）例CR、4（12%）例PR、1例（3% ）PD。1年总生存率100%,1年无病生存率91%。主要不良反应包括白细胞下降,血小板减少反应,肝功能损害,均可逆转。结论 PGC三药方案诱导化疗序贯同步放化疗治疗Ⅲ~ⅣA期鼻咽癌疗效较好,不良反应可耐受。     

Comparison of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by radiation vs concurrent chemoradiotherapy with TPF in patients with locally advanced squamous cell carcinoma of the head and neck

AimsTo compare the effectiveness of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) followed by radiation with that of concurrent chemoradiotherapy with TPF in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).Materials and methodsIn a group of patients receiving induction chemotherapy followed by radiation, 15 patients received two cycles of chemotherapy with docetaxel 60 mg/m², cisplatin 70 mg/m² and 5-day 5-fluorouracil (5-FU) 750 mg/m²/day. Radiotherapy was begun 21 days after completing chemotherapy. In the group receiving concurrent chemoradiotherapy, 19 patients received two cycles of chemotherapy with docetaxel 50 mg/m², cisplatin 60 mg/m², and 5-day 5-FU 600 mg/m²/day. Radiation was begun on the first day of chemotherapy. The total radiation dose was between 63 and 74 Gy.ResultsOverall response rate (partial and complete response — both 100%) and complete response rate (87% and 84%) were similar, but, in overall survival, concurrent chemoradiotherapy with TPF was better than induction chemotherapy with TPF followed by radiation. Mucositis and anaemia were more frequent in the group receiving concurrent chemoradiotherapy, but the group receiving concurrent chemoradiotherapy with TPF improved overall survival.ConclusionsThis is a small non-randomised comparison. The effectiveness of concurrent chemoradiotherapy with TPF was better than that of induction chemotherapy with TPF followed by radiation.     

Induction chemotherapy for head and neck cancer: recent data

The addition of chemotherapy to radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) patients improves survival. Meta-analyses of randomized trials have indicated that the benefit of this approach is associated with the timing of chemotherapy administration. It has been demonstrated that the greatest survival benefit over locoregional treatment alone is seen with the concurrent administration of chemotherapy and radiotherapy. However, sequential chemotherapy administration, in the form of induction chemotherapy followed by radiotherapy or concurrent chemoradiotherapy, has been successful as a strategy for organ function preservation in patients with potentially resectable SCCHN. In addition, a meta-analysis of trials using platinum and 5-fluorouracil (PF)-containing induction regimens demonstrated a significant survival benefit for this approach over locoregional treatment alone in locally advanced disease. In recent years, the introduction of the taxanes into induction chemotherapy has provided physicians with more active regimens. The triplet combination induction regimen of docetaxel, cisplatin, and 5-fluorouracil has been shown to be more effective in prolonging survival than the doublet PF. Current trials are testing whether the addition of induction chemotherapy to standard concomitant chemoradiotherapy is superior to concomitant chemoradiotherapy alone.     

Current perspectives on treatment strategies for locally advanced, unresectable stage III non-small cell lung cancer

The treatment of unresectable stage III NSCLC remains challenging. However, in the last two decades, advances in terms of survival prolongation have been made, first by administering chemotherapy with definitive thoracic radiotherapy sequentially, and then by administering these two modalities concurrently. Most recently, induction and consolidation regimens have been evaluated which involve adding chemotherapy before concurrent chemoradiotherapy (as induction) or after (as consolidation). Thus far, the consolidation approach appears to be promising. For example, concurrent chemoradiotherapy with cisplatin and etoposide followed by consolidation docetaxel yielded an impressive median survival of 26 months in a Southwest Oncology Group phase II trial. A phase III trial showed interesting results in a subset of patients that received docetaxel consolidation prior to randomization to gefitinib or placebo. Although stopped early due to lack of benefit of gefitinib, preliminary results showed a median survival time of 29 months in the placebo arm. A randomized trial is currently underway that compares concurrent chemoradiotherapy (using cisplatin and etoposide) followed by either docetaxel consolidation or no further therapy.     

多西他赛加顺铂诱导化疗联合同期放化疗局部晚期非小细胞肺癌的临床观察

目的 评价TP方案诱导化疗联合同期放化疗局部晚期非小细胞肺癌的近期疗效和不良反应。方法 病理证实的局部晚期非小细胞肺癌86例,随机分成同期放化疗联合TP方案诱导化疗(ICCRT) 组和单纯同期放化疗(CCRT) 组。放疗均采用调强放疗。治疗结束后比较两组疗效、生存率和不良反应。结果 86例患者的随访率为100%。ICCRT组和CCRT组的有效率分别为80%和70%(χ²=1.26,P=0.261),1、2、3年总生存率分别为85%和65%、50%和40%、44%和33%(χ²=3.90,P=0.048),主要不良反应白细胞减少(43例和32例,χ²=3.48,P=0.062)、放射性食管炎(26例和20例,χ²=0.12,P=0.730)、血红蛋白减低(26例和16例,χ²=2.34,P=0.126)和放射性肺炎(13例和9例,χ²=0.37,P=0.541)。结论 ICCRT能明显提高局部晚期非小细胞肺癌的总生存率,且与CCRT相比并不增加局部不良反应。     

Induction or consolidation chemotherapy for unresectable stage III non-small-cell lung cancer patients treated with concurrent chemoradiation: a randomised phase II trial GFPC – IFCT 02-01

PurposeThe objective of this randomised phase II study was to evaluate the impact in terms of response and toxicities of induction or consolidation chemotherapy respectively before or after concurrent chemoradiotherapy in unresectable stage III non-small-cell lung cancer.Patients and methodsIn the induction arm, patients received induction chemotherapy with cisplatin (80 mg/m²) and paclitaxel (200 mg/m²) on days 1 and 29 followed by a concurrent chemoradiotherapy (66 Gy in 33 fractions, cisplatin 80 mg/m² days 1, 29 and 57, vinorelbine 15 mg/m² days 1, 8, 29, 36, 57 and 64). In consolidation arm, the same concurrent chemoradiotherapy began on day 1 followed by two cycles of cisplatin and paclitaxel.ResultsOne hundred twenty seven patients were randomised. The intent to treat response rates in induction and consolidation arms were 58% and 56% respectively. Median survival was 19.6 months in induction arm and 16.3 months in consolidation arm and 4-year survival rates were 21% and 30% respectively. Haematologic and non-haematologic toxicities were similar in both arms, except grade 3/4 oesophagitis, more frequent in consolidation arm than in induction arm (17% versus 10%).ConclusionCisplatin-based chemotherapy as induction or consolidation with concurrent chemoradiotherapy can be administrated safely. Response rates were similar in both arms with a trend in favour for consolidation arm for long-term survival.     

Comparative study of induction chemotherapy and chemoradiotherapy in the treatment of limited-disease small cell lung cancer with ipsilateral pleural effusion

Objective  

The aim of the study was to explore the effects and side effects of induction chemotherapy followed by chemoradiotherapy for limited-disease small cell lung cancer (LD-SCLC) patients with ipsilateral pleural effusion.     

三维适形放疗同步卡培他滨化疗治疗老年胃癌

目的:研究三维适形放疗同步卡培他滨化疗治疗老年胃癌患者的疗效、生存时间和不良反应。方法:本院收治的45例老年胃癌患者随机分为卡培他滨单药化疗组（21例）和三维适形放疗同步卡培他滨化疗组（24例）。PTV剂量1.8Gy/(25f·5w),放疗开始同步卡培他滨化疗。比较两组患者的疗效、生存时间和不良反应。结果:卡培他滨单药化疗组客观缓解率61.9%,三维适形放疗同步卡培他滨化疗组客观缓解率87.5%,有显著统计学差异(P＜0.05)。两组不良反应、生活质量无显著差异。卡培他滨单药化疗组2年生存率23.8%,三维适形放疗同步卡培他滨化疗组2年生存率50.0%,有显著统计学差异(P＜0.05)。结论:三维适形放疗同步卡培他滨化疗治疗老年胃癌可以有效提高患者的治疗效果,改善预后,不良反应可以耐受,是一种安全有效的治疗方案。