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目的观察三维适形放疗联合紫杉醇卡铂周方案同步化疗局部晚期非小细胞肺癌的疗效及毒副反应。方法将94例局部晚期非小细胞肺癌患者分为同步A、B组及序贯组,分别为33、293、2例。均采用三维适形放射治疗,2 Gy/次,总剂量70 Gy。同步A组采用紫杉醇50 mg/m2+卡铂AUC1.5,给药时点1、81、5、293、6、43 d。同步B组方法同A组,但紫杉醇为40 mg/m2。序贯组采用紫杉醇150 mg/m2卡铂AUC5,21 d为1周期,放疗前使用2个周期。结果同步A、B组、序贯组的有效率〔完全缓解(CR)+部分缓解(PR)〕分别为81.8%、79.3%、56.2%。序贯组与同步组的差异有统计学意义。3组的中位生存期分别为18.8、17.6、15.6个月;1、2年总生存率分别为74.0%、41.0%;72.0%、39.0%;69.0%、35.0%,组内差异无统计学意义。3组的Ⅱ、Ⅲ级急性放射性食管炎、Ⅱ、Ⅲ级急性放射性肺炎和Ⅱ、Ⅲ级骨髓抑制发生率分别为60.6%、24.2%4、2.4%;58.6%、24.1%、44.8%;40.6%、21.9%、18.8%。结论紫杉醇加卡铂周方案联合同步放疗,与序贯放化疗相比,可提高局部晚期非小细胞肺癌的近期疗效,生存期也有提高的趋势,但毒副反应有增加趋势。
Objective To observe the curative effect and side effects of three-dimensional conformal radiotherapy combined with paclitaxel carboplatin regimen in the concurrent chemotherapy of locally advanced non-small cell lung cancer. Methods 94 cases of locally advanced non-small cell lung cancer patients were divided into synchronous A, B group and sequential group, respectively, 33,293,2 cases. All three-dimensional conformal radiotherapy, 2 Gy / time, the total dose of 70 Gy. The patients in group A were treated with paclitaxel 50 mg / m2 + carboplatin AUC1.5, and the time points of administration were 1,81,5,293,6,43 d. The method of group B was the same as that of group A, but paclitaxel was 40 mg / m2. Sequential group with paclitaxel 150 mg / m2 carboplatin AUC5, 21 d for the 1 cycle, 2 cycles before radiotherapy. Results The effective rate (complete remission (CR) + partial remission (PR)] in group A and group B were 81.8%, 79.3% and 56.2%, respectively. The difference between sequential group and synchronous group was statistically significant. The median survival time was 18.8, 17.6 and 15.6 months in the three groups, respectively. The overall survival rates at 1 and 2 years were 74.0%, 41.0%, 72.0%, 39.0%, 69.0% and 35.0% significance. The incidence of grade Ⅱ and Ⅲ acute radiation esophagitis, grade Ⅱ and Ⅲ acute radiation pneumonitis and grade Ⅱ and Ⅲ myelosuppression in 3 groups were 60.6%, 24.2%, 4,2.4%, 58.6%, 24.1% and 44.8% respectively; 40.6 %, 21.9%, 18.8%. Conclusions Paclitaxel plus carboplatin week combined with concurrent radiotherapy, compared with sequential chemoradiotherapy, can improve the short-term efficacy of locally advanced non-small cell lung cancer, but also increase the survival time, but there is an increasing trend of toxicity.