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。

Comparison of efficacy between concurrent chemoradiotherapy followed by consolidation chemotherapy and sequential chemoradiotherapy for locally advanced non-small cell lung cancer

Objective To compare the efficacy and adverse reaction of concurrent chemoradiotherapy followed by consolidation chemotherapy（ CCRT-CT） and sequential chemoradiotherapy（ SCRT） for the locally advanced non-small cell lung cancer. Methods Patients with locally advanced NSCLC from Jan 2010 and Dec 2012 were enrolled and divided into two groups in random. One group,enrolled in 37 cases, were given CCRT-CT; The other,enrolled in 40 cases,were given SCRT. CCRT-CT group received two cycles of EP（ cisplatin ＋ etoposide） regimen chemotherapy concurrent radiotherapy at the first week and the fifth week. Then they were consolidated by 2 to 4 cycles of docetaxel single drug. SCRT group received 2 to 4 cycles of TP regimen chemotherapy followed by radiotherapy or radiotherapy followed by TP chemotherapy. Radiotherapy was administered using two-dimensional conformal irradiation（ 60-66 Gy /30-33f /42-45d）. Results The response rate of CCRT-CT and SCRT group was 83. 8 % and 55. 0 %,respectively（ P〈0. 05）. The median survival time in the two groups was 18. 0 and 15. 0 months,respectively; The 1-,2-year overall survival rates were 75. 4%,49. 2% in CCRT-CT group,66. 5%,40. 7% in SCRT group,respectively（ P〈0. 05）. The main adverse reactions included radiation pneumonitis,radiation esophagitis,nausea/vomiting and anemia / leucopenia / thrombocytopenia. CCRT-CT group had a significantly higher rate of III-IV grade nausea / vomiting and anemia / leucopenia / thrombocytopenia than SCRT group. Conclusions Compared to SCRT,CCRT-CT can improve the response rate and overall survival of locally advanced non-small cell lung cancer. However,it can be associated with a higher rate of adverse reaction,especially radiation pneumonitis,radiation esophagitis. Therefore,we should choose different treatment for different patients.