202 中国临床肿瘤学教育专辑 (2007)

    化疗方案对局部晚期非小细胞肺癌同步放化疗的影响分析

    中国医学科学院肿瘤医院 任 华 王绿化 王小震 吕纪马 周宗玫 欧广飞 殷蔚伯

    Abstract Objective: To retrospectively analyze the effects of different concurrent chemotherapy

    regimens on locally advanced non–small-cell lung carcinoma (NSCLC).Methods and Materials: Data

    were analyzed from 106 patients pathologically diagnosed as NSCLC (Ⅲa:29,Ⅲb:77) and received

    concurrent external beam radiotherapy with various chemotherapy regimens. Analysis was performed

    for overall survival, progression-free survival, and toxicity (grade≥2). Results: Paclitaxel based

    chemotherapy regimen was delivered in 55 patients (51.9%), whereas 21 patients(19.8%) with

    topotecan regimen and 26 patients (24.5%)with PE (cisplatin and etopside) regimen, 4 patients had

    other chemotherapy regimens . The median follow-up time for surviving patients was 14.4 months, the

    median survival time was 18.6 months, the overall 1-，2- and 3-year survival rate were 72.2%, 41.1%

    and 27.5%, respectively. Survival and toxicity analysis were performed in 102 patients which included

    paclitaxel , topotecan and PE groups , the median survival time was 16.3 months, 27.3 months and 29.1

    months, respectively. The overall survivals of topotecan and PE groups were superior to paclitaxel

    based group, but not signifcant (P=0.32). Howerevr, when topotecan and PE group were combined (47

    patients) and compared to paclitaxel based regimen group, the median survival was poorer in patients

    with paclitaxel based regimen (16.3 months vs 27.3 months), and both in univariate and multivariate

    analysis paclitaxel based chemotherapy regimen was significantly associated with poorer survival (P<

    0.05). N stage was significant in the Cox multivariate regression model. Paclitaxel based regimen was

    associated with more acute radiation pneumonitis, 27.3% versus 10.6%, (P=0.03), less blood toxicity

    (16.4% vs 29.8%) (P=0.108) and almost same esophagitis(29.1% vs 34.0%). Conclusions: This

    retrospective analysis showed a correlation between concurrent chemotherapy regimens with survival

    and toxicity in patients with locally advanced NSCLC. Further study for chemotherapy regimens in

    concurrent chemoradiation is needed.

    Key Words Non–small-cell lung carcinoma； Radiotherapy； Chemotherapy； Regimen； Treatment

    局部晚期非小细胞肺癌占非小细胞肺癌的30%~40%，单纯放疗5年生存率只有5%~10%[1]

    ，序贯化放

    疗与其相比可以提高5年生存率8%~17%[2-4]

    ，患者预后仍然不佳。二十世纪后期开始，国外多个Ⅰ-Ⅱ期

    临床试验显示同步放化疗可取得较为理想的疗效[5-9]

    ，多个研究中心的Ⅲ期临床研究证实以同步放化疗为

    主的治疗模式可提高局部晚期非小细胞肺癌的生存率[10-15]

    ，同步放化疗已成为局部晚期非小细胞肺癌的

    标准治疗。目前不同研究中心开展同步治疗研究选用的化疗方案不一，尚未见到针对同步治疗的化疗方

    案的临床研究意见。我院自1999年以来开展了的多种化疗方案的同步放化疗治疗局部晚期非小细胞肺癌

    的临床实践，本文采用队列研究的方法比较我院1999年4月~2005年10月采用不同化疗方案的同步放化疗

    治疗局部晚期非小细胞肺癌的疗效及毒性反应。

    一、 材料与方法

    (一) 入组标准

    经细胞学或病理证实为非小细胞肺癌的患者，入组时无远处转移证据，2002年UICC TNM分期Ⅲ期；

    既往无放化疗史，治疗前血象以及肝肾功能无异常。患者自愿接受治疗并于治疗前签署放疗和化疗知情中国临床肿瘤学教育专辑 (2007) 203

    同意书。

    (二) 一般临床资料

    1999年4月~2005年10月，共106例患者入组，其中男93例，女14例，中位年龄57.50岁(26~77岁)。TNM

    分期Ⅲa期29例，Ⅲb77例，余详见表1。

    表1 106例患者一般临床资料

    项目 例数(%) 项目 例数(%)

    KPS 3(2.83，未评价) T 5(4.72，未评价)

    ≥80 94(88.7) T1 4(3.77)

    <80 9(8.49) T2 35(33.02)

    病理类型 T3 25(23.58)

    鳞癌 68(64.15) T4 37(34.90)

    腺癌 27(25.47) N 4(3.77 ......