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 chemotherapyregimens on locally advanced non–small-cell lung carcinoma (NSCLC).Methods and Materials: Datawere analyzed from 106 patients pathologically diagnosed as NSCLC (Ⅲa:29,Ⅲb:77) and receivedconcurrent external beam radiotherapy with various chemotherapy regimens. Analysis was performedfor overall survival, progression-free survival, and toxicity (grade≥2). Results: Paclitaxel basedchemotherapy regimen was delivered in 55 patients (51.9%), whereas 21 patients(19.8%) withtopotecan regimen and 26 patients (24.5%)with PE (cisplatin and etopside) regimen, 4 patients hadother chemotherapy regimens . The median follow-up time for surviving patients was 14.4 months, themedian 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 includedpaclitaxel , topotecan and PE groups , the median survival time was 16.3 months, 27.3 months and 29.1months, respectively. The overall survivals of topotecan and PE groups were superior to paclitaxelbased group, but not signifcant (P=0.32). Howerevr, when topotecan and PE group were combined (47patients) and compared to paclitaxel based regimen group, the median survival was poorer in patientswith paclitaxel based regimen (16.3 months vs 27.3 months), and both in univariate and multivariateanalysis 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 wasassociated 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: Thisretrospective analysis showed a correlation between concurrent chemotherapy regimens with survivaland toxicity in patients with locally advanced NSCLC. Further study for chemotherapy regimens inconcurrent 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%，序贯化放疗与其相比可以提高5年生存率8%～17%，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，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，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。
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