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目的探讨局部晚期非小细胞肺癌(NSCLC)同期放化疗加巩固化疗与序贯放化疗的近期和远期疗效及不良反应。方法选取2010年1月至2012年12月住院治疗的77例局部晚期非小细胞肺癌患者,随机分为同期加巩固组(37例)和序贯组(40例)。同期加巩固组患者在第1周、第5周分别给予依托泊苷+顺铂(EP方案)化疗,之后给予单药多西他赛巩固化疗2～4个周期。序贯组患者先行多西他赛+顺铂(TP方案)化疗2～4个周期,再行放射治疗或先放射治疗后给予TP方案化疗2～4个周期。放射治疗为常规普通放疗(总剂量60～66Gy,分30～33次,5～6周完成)。结果两组患者有效率分别为83.8%和55.0%,差异有统计学意义(P<0.05);两组患者的中位生存时间分别为18.0个月和15.0个月,1年生存率分别为75.4%和66.7%,2年生存率分别为49.2%和40.7%,差异有统计学意义(P<0.05)。不良反应主要为骨髓抑制、放射性食管炎、放射性肺炎及胃肠反应。同期加巩固组患者的不良反应发生率明显高于序贯组,差异有统计学意义(P<0.05)。结论同期加巩固化疗相比于传统的序贯放化疗,可以提高局部晚期非小细胞肺癌患者近期有效率,延长生存时间,但不良反应相应增加,尤其是骨髓抑制和放射性食管炎,临床应根据患者具体情况选择应用。
Objective To investigate the short-term and long-term effects and adverse reactions of concurrent chemoradiotherapy plus consolidation chemotherapy and sequential chemoradiotherapy in locally advanced non-small cell lung cancer (NSCLC). Methods A total of 77 patients with locally advanced non-small cell lung cancer admitted to our hospital from January 2010 to December 2012 were randomly divided into two groups: treatment group (37 cases) and sequential group (40 cases). Patients in the same period plus consolidation group were given etoposide plus cisplatin (EP regimen) chemotherapy in the first week and the fifth week, and then were given 2 to 4 cycles of single-agent docetaxel consolidation chemotherapy. Patients in the sequential group were treated with docetaxel plus cisplatin (TP regimen) for 2 to 4 cycles, followed by 2 to 4 cycles of TP regimen after radiotherapy or radiation therapy. Radiation therapy for conventional radiotherapy (total dose of 60 ~ 66Gy, 30 to 33 times, 5 to 6 weeks to complete). Results The effective rates of the two groups were 83.8% and 55.0%, respectively, with significant difference (P <0.05). The median survival time was 18.0 months and 15.0 months respectively, and the 1-year survival rates were 75.4 % And 66.7% respectively. The 2-year survival rates were 49.2% and 40.7% respectively, with statistical significance (P <0.05). Adverse reactions mainly bone marrow suppression, radiation esophagitis, radiation pneumonitis and gastrointestinal reactions. In the same period, the incidence of adverse reactions in patients with consolidation group was significantly higher than that in sequential group (P <0.05). Conclusions Compared with traditional sequential chemoradiotherapy, consolidation chemotherapy in the same period can improve the recent efficiency and prolong the survival time of patients with locally advanced non-small cell lung cancer, but with a corresponding increase in adverse reactions, especially myelosuppression and radiation esophagitis, and should be based on Patients choose the specific situation.