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目的:评价不能手术局部晚期非小细胞肺癌(NSCLC)患者同步或序贯放化疗的疗效和不良反应。方法:2011年7月至2013年12月间初治接受同步或序贯放化疗的85例患者入组本研究,其中45例同步放化疗患者列入A组,40例序贯放化疗患者列入B组。A组采用放疗同步紫杉醇、顺铂化疗,B组采用单纯放疗,放疗结束后行紫杉醇、顺铂化疗。两组放疗方法相同,均为三维适型放疗,剂量60Gy/30f。对比两组治疗的疗效、不良反应和1、2年生存率。结果:85例患者均可评价疗效,随访率100%。A组与B组有效率分别为73.3%和50.0%(P<0.05);1年局部控制率分别为51.1%和30.0%(P<0.05);1年生存率分别为62.2%和42.5%(P>0.05);2年生存率分别为37.8%和17.5%(P<0.05)。A组≥Ⅲ级放射性肺炎、放射性食管炎及Ⅲ~Ⅳ级骨髓抑制的发生率分别为6.7%、11.1%和28.9%,B组分别为5.0%、10.0%和27.5%。两组不良反应相似,均可耐受。结论:局部晚期NSCLC同步放化疗的疗效优于序贯放化疗,不良反应可耐受,同步放化疗是不能手术的局部晚期NSCLC标准治疗方法。
PURPOSE: To evaluate the efficacy and side effects of concurrent or sequential chemoradiotherapy in patients with locally advanced non-small cell lung cancer (NSCLC) who can not undergo surgery. Methods: From July 2011 to December 2013, 85 patients who underwent concurrent chemoradiation or sequential chemoradiotherapy were enrolled in this study. Among them, 45 patients undergoing concurrent chemoradiotherapy were enrolled in group A and 40 patients underwent sequential chemoradiotherapy Into the B group. In group A, paclitaxel and cisplatin were used simultaneously with radiotherapy. Group B was treated with radiotherapy alone. Paclitaxel and cisplatin were given after the end of radiotherapy. Radiotherapy two methods the same, are three-dimensional conformal radiotherapy, dose 60Gy / 30f. The curative effect, adverse reaction and 1, 2 year survival rate of two groups were compared. Results: All 85 patients could evaluate the curative effect, the follow-up rate was 100%. The effective rates in group A and group B were 73.3% and 50.0%, respectively (P <0.05). The local control rates in one year were 51.1% and 30.0%, respectively (P <0.05). The 1-year survival rates were 62.2% and 42.5% P> 0.05). The 2-year survival rates were 37.8% and 17.5%, respectively (P <0.05). The incidence of grade Ⅲ pneumonia, radiotherapy esophagitis and grade Ⅲ-Ⅳ myelosuppression in group A were 6.7%, 11.1% and 28.9% respectively, and in group B 5.0%, 10.0% and 27.5% respectively. Two groups of similar adverse reactions, can be tolerated. Conclusions: The efficacy of concurrent chemoradiotherapy in locally advanced NSCLC is better than that of sequential chemoradiotherapy. The adverse reactions are tolerable. Chemoradiation is a standard treatment for locally advanced non-operative NSCLC.