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目的探讨吉非替尼联合同步放疗治疗表皮生长因子受体突变型晚期非小细肺癌(non-small cell lung cancer,NSCLC)的疗效、不良反应及生存情况。方法将2008年1月—2014年2月收治的表皮生长因子受体(epithelial growth factor receptor,EGFR)突变型晚期非小细肺癌患者分为同步组60例和序贯组38例,同步组采用吉非替尼联合同步放疗治疗(吉非替尼250 mg/d),而序贯组采用先服用吉非替尼直至疾病进展,再进行放疗。统计两组的疗效、不良反应、无进展生存时间(progression-free survival,PFS)、总生存期(overall survival,OS)、1年生存率和2年生存率,利用R×C表的χ2检验和2×2表的χ2检验分析相关数据。结果在同步组中出现缓解(partial response,PR)、进展(progress of disease,PD)、有效(response rate,RR)和疾病控制(disease control rate,DCR)的比例分别为76.67%、1.67%、86.67%和98.33%,而在序贯组出现PR、PD、RR和DCR的比例分别55.26%、15.79%、65.79%和84.21%。有消化道反应的患者在同步组和序贯组的比例分别为68.33%和47.37%,而有转氨酶升高的患者则分别为23.33%和5.26%。患者出现PR、PD、RR、DCR、消化道反应、转氨酶升高和2年生存率在同步组与序贯组之间的差异有统计学意义(P<0.05)。完全缓解、部分缓解、稳定和进展的构成比在两组间的差异有统计学意义(P<0.05)。结论治疗EGFR突变型晚期非小细肺癌采取吉非替尼联合同步放疗的方案是可取的。
Objective To investigate the efficacy, side effects and survival of gefitinib combined with concurrent radiotherapy in the treatment of epidermal growth factor receptor mutant non-small cell lung cancer (NSCLC). Methods Patients with advanced non-small cell lung cancer with epithelial growth factor receptor (EGFR) mutation admitted from January 2008 to February 2014 were divided into two groups: synchronous group (60 cases) and sequential group (38 cases) Gefitinib combined with concurrent radiotherapy (gefitinib 250 mg / d), while the sequential group using gefitinib until the disease progression, followed by radiotherapy. The curative effect, adverse reaction, progression-free survival (PFS), overall survival (OS), 1-year survival rate and 2-year survival rate were compared between the two groups. The chi square test And 2 × 2 table χ2 test analysis of relevant data. Results The proportions of partial response (PR), progress of disease (PD), response rate (RR) and disease control rate (DCR) in the synchronized group were 76.67% and 1.67% 86.67% and 98.33% respectively, while the proportions of PR, PD, RR and DCR in sequential group were 55.26%, 15.79%, 65.79% and 84.21% respectively. The proportion of patients with digestive tract reaction was 68.33% and 47.37% respectively in the synchronous group and the sequential group, while the patients with elevated aminotransferases were 23.33% and 5.26% respectively. The differences of PR, PD, RR, DCR, gastrointestinal reaction, elevated transaminase and 2-year survival rate between the synchronous group and the sequential group were statistically significant (P <0.05). The proportions of complete remission, partial remission, stability and progression were statistically different between the two groups (P <0.05). Conclusion It is advisable to adopt gefitinib combined with concurrent radiotherapy in the treatment of advanced non-small cell lung cancer with EGFR mutation.