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背景与目的临床约2/3的Ⅲ期非小细胞肺癌患者确诊时已失去手术机会,单纯放疗或化疗疗效均不理想,5年生存率只有5%~10%。同步放化疗的不同治疗方法间有协同作用,可获得更好的局部控制率和生存率,有报道5年生存率为15.8%。但其毒副反应较大。本研究前瞻性比较两种同步放化疗方案治疗不能手术的Ⅲ期非小细胞肺癌的疗效及毒副反应,以期取得较佳疗效的同时,降低毒副作用。方法48例不能手术的Ⅲ期非小细胞肺癌患者,随机分成两组,紫杉醇每周小剂量组(每周小剂量组)和3周紫杉醇+顺铂(DDP)常规剂量组(对照组)。两组的放疗方法相同,均采用常规分割放疗。每次2.0Gy,每周5次,原发肿瘤灶总剂量60~64Gy。每周小剂量组在放疗同时给予紫杉醇每周45mg/m2,连用6周;对照组给予紫杉醇135mg/m2,第1、22天+DDP50mg/m2第2~4天,第23~25天。结果每周小剂量组和对照组的有效(CR+PR)率分别为79%和75%(P>0.05),而两组CR率分别21%和13%(P<0.05)。1、2、3和5年生存率分别为83%、63%、38%、13%和63%、42%、17%、8%,差异接近显著性意义。紫杉醇每周小剂量组重度毒副反应小,但两组间差异无显著性意义(P>0.05)。结论紫杉醇每周小剂量同步放化疗方案组可降低毒副反应,并有望延长生存时间。
BACKGROUND & OBJECTIVE: About two-thirds of patients with stage III non-small cell lung cancer have lost the chance of surgery at the time of diagnosis. The efficacy of radiotherapy alone or chemotherapy is unsatisfactory, and the 5-year survival rate is only 5% -10%. The synergistic effects of different chemotherapies on concurrent chemoradiation have led to better local control and survival rates, and a 5-year survival rate of 15.8% has been reported. However, its toxic side effects. This study prospectively compared the efficacy of two concurrent chemoradiation regimens in the treatment of inoperable stage III non-small cell lung cancer, with a view to achieving better efficacy and reducing side effects. Methods Forty-eight patients with unresectable stage Ⅲ non-small cell lung cancer were randomly divided into two groups: paclitaxel weekly low dose group (weekly low dose group) and paclitaxel plus cisplatin (DDP) conventional dose group (control group). Radiotherapy methods in both groups are the same, using conventional radiotherapy. Each 2.0Gy, 5 times a week, the total primary tumor dose 60 ~ 64Gy. Weekly low-dose group was treated with paclitaxel 45mg / m2 weekly for 6 weeks. The control group was given paclitaxel 135mg / m2, days 1,22 + DDP50mg / m2 for days 2-4, and days 23-25. Results The effective rate of CR + PR in the low-dose group and the control group was 79% and 75% respectively (P> 0.05), while the CR rates in both groups were 21% and 13%, respectively (P <0.05). The 1, 2, 3 and 5-year survival rates were 83%, 63%, 38%, 13% and 63%, 42%, 17% and 8%, respectively. Paclitaxel weekly low-dose group of severe side effects, but no significant difference between the two groups (P> 0.05). Conclusion Paclitaxel weekly low-dose concurrent chemoradiotherapy program can reduce the side effects and is expected to extend the survival time.