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目的 评价化、放同步治疗与单纯放射治疗ⅢA/ⅢB期非小细胞肺癌 (NSCLC)的疗效及毒副反应。方法 5 6例ⅢA/ⅢB期NSCLC患者被随机分成同步放化疗组 (同步组 )和单纯放疗组 (单放组 ) ,单放组为原发灶和区域淋巴结前程超分割照射 ,每次 1.2Gy ,每天 2次 ,总量 45 .6Gy ;后程加速超分割照射 ,每次1.6Gy ,每天 2次 ,肿瘤灶总量为 68Gy。同步组在放疗同时给予足叶乙甙 5 0mg/m2 ,顺铂 2 0mg/m2 ,第 1～ 3、15～ 17、2 9～ 3 1天。结果 同步组有效率为 78.6% (2 2 /2 8) ,其中完全缓解 (CR) 10例 ,部分缓解 (PR) 12例。单放组有效率为 3 9.3 % (11/2 8) ,均为PR。同步组的有效率明显高于单放组 (P =0 .0 0 3 )。同步组和单放组的中位生存时间分别为 16和 13个月 (P =0 .0 0 0 3 )。同步组的远处转移率 (5 7.1% )明显低于单放组 (85 .7% ) (P =0 .0 18)。同步组Ⅲ～Ⅳ度放射性食管炎、中性粒细胞减少发生率分别为 3 9.3 % (11/2 8)、17.9% (5 /2 8) ,高于单放组的 17.9% (5 /2 8)和 3 .6% (1/2 8) ,但均无统计学差异 (P =0 .0 76和 0 .0 84)。结论 化、放同步治疗是ⅢA/ⅢB期非小细胞肺癌安全有效的治疗手段 ,值得进一步临床研究。
Objective To evaluate the curative effect and toxicity of ⅢA / ⅢB non-small cell lung cancer (NSCLC) treated with radiotherapy and concurrent radiotherapy. Methods Fifty-six patients with stage ⅢA / ⅢB NSCLC were randomly divided into concurrent chemoradiotherapy group (single group) and radiotherapy group (single radiotherapy group). The single radiotherapy group was divided into two groups: primary tumor and regional lymph node , Twice a day, a total of 45.6Gy; late accelerated hyperfractionated irradiation, each 1.6Gy, 2 times a day, the total amount of tumor focus 68Gy. The patients in the synchronous group were treated with 50 mg of etoposide and 20 mg / m2 of cisplatin respectively during the first three days of radiotherapy. Results The effective rate of synchronous group was 78.6% (2 2/2 8), of which 10 cases were complete remission (CR) and 12 cases were partial remission (PR). The single group was effective rate of 9.39% (11/2 8), are PR. The efficiency of the synchronous group was significantly higher than that of the single radiotherapy group (P = 0.030). Median survival time was 16 and 13 months in the synchronous group and in the radiotherapy alone group (P = .0 0 0 3), respectively. The distant metastasis rate (57.1%) in the synchronous group was significantly lower than that in the single radiotherapy group (85.7%) (P = 0.018). The incidence of grade Ⅲ-Ⅳ radiation esophagitis and neutropenia in synchronized group was 33.3% (11/2 8), 17.9% (5/28), respectively, higher than 17.9% (5/2) 8) and 3.6% (1/2 8), respectively, but no significant difference (P = 0.076 and 0.84). Conclusions The concurrent and concurrent treatment is a safe and effective treatment for stage ⅢA / ⅢB non-small cell lung cancer and deserves further clinical study.