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202 中國臨床腫瘤學(xué)教育專輯 (2007)
化療方案對局部晚期非小細胞肺癌同步放化療的影響分析
中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院 任 華 王綠化 王小震 呂紀馬 周宗玫 歐廣飛 殷蔚伯
Abstract Objective: To retrospectively analyze the effects of different concurrent chemotherapy
regimens on locally advanced non–small-cell lung carcinoma (NSCLC).Methods and Materials: Data
were analyzed from 106 patients pathologically diagnosed as NSCLC (Ⅲa:29,Ⅲb:77) and received
concurrent external beam radiotherapy with various chemotherapy regimens. Analysis was performed
for overall survival, progression-free survival, and toxicity (grade≥2). Results: Paclitaxel based
chemotherapy regimen was delivered in 55 patients (51.9%), whereas 21 patients(19.8%) with
topotecan regimen and 26 patients (24.5%)with PE (cisplatin and etopside) regimen, 4 patients had
other chemotherapy regimens . The median follow-up time for surviving patients was 14.4 months, the
median survival time was 18.6 months, the overall 1-，2- and 3-year survival rate were 72.2%, 41.1%
and 27.5%, respectively. Survival and toxicity analysis were performed in 102 patients which included
paclitaxel , topotecan and PE groups , the median survival time was 16.3 months, 27.3 months and 29.1
months, respectively. The overall survivals of topotecan and PE groups were superior to paclitaxel
based group, but not signifcant (P=0.32). Howerevr, when topotecan and PE group were combined (47
patients) and compared to paclitaxel based regimen group, the median survival was poorer in patients
with paclitaxel based regimen (16.3 months vs 27.3 months), and both in univariate and multivariate
analysis paclitaxel based chemotherapy regimen was significantly associated with poorer survival (P<
0.05). N stage was significant in the Cox multivariate regression model. Paclitaxel based regimen was
associated with more acute radiation pneumonitis, 27.3% versus 10.6%, (P=0.03), less blood toxicity
(16.4% vs 29.8%) (P=0.108) and almost same esophagitis(29.1% vs 34.0%). Conclusions: This
retrospective analysis showed a correlation between concurrent chemotherapy regimens with survival
and toxicity in patients with locally advanced NSCLC. Further study for chemotherapy regimens in
concurrent chemoradiation is needed.
Key Words Non–small-cell lung carcinoma； Radiotherapy； Chemotherapy； Regimen； Treatment
局部晚期非小細胞肺癌占非小細胞肺癌的30%~40%，單純放療5年生存率只有5%~10%[1]
，序貫化放
療與其相比可以提高5年生存率8%~17%[2-4]
，患者預(yù)后仍然不佳。二十世紀后期開始，國外多個Ⅰ-Ⅱ期
臨床試驗顯示同步放化療可取得較為理想的療效[5-9]
，多個研究中心的Ⅲ期臨床研究證實以同步放化療為
主的治療模式可提高局部晚期非小細胞肺癌的生存率[10-15]
，同步放化療已成為局部晚期非小細胞肺癌的
標(biāo)準(zhǔn)治療。目前不同研究中心開展同步治療研究選用的化療方案不一，尚未見到針對同步治療的化療方
案的臨床研究意見。我院自1999年以來開展了的多種化療方案的同步放化療治療局部晚期非小細胞肺癌
的臨床實踐，本文采用隊列研究的方法比較我院1999年4月~2005年10月采用不同化療方案的同步放化療
治療局部晚期非小細胞肺癌的療效及毒性反應(yīng)。
一、 材料與方法
(一) 入組標(biāo)準(zhǔn)
經(jīng)細胞學(xué)或病理證實為非小細胞肺癌的患者，入組時無遠處轉(zhuǎn)移證據(jù)，2002年UICC TNM分期Ⅲ期；
既往無放化療史，治療前血象以及肝腎功能無異常�；颊咦栽附邮苤委煵⒂谥委熐昂炇鸱暖熀突熤橹袊R床腫瘤學(xué)教育專輯 (2007) 203
同意書。
(二) 一般臨床資料
1999年4月~2005年10月，共106例患者入組，其中男93例，女14例，中位年齡57.50歲(26~77歲)。TNM
分期Ⅲa期29例，Ⅲb77例，余詳見表1。
表1 106例患者一般臨床資料
項目 例數(shù)(%) 項目 例數(shù)(%)
KPS 3(2.83，未評價) T 5(4.72，未評價)
≥80 94(88.7) T1 4(3.77)
<80 9(8.49) T2 35(33.02)
病理類型 T3 25(23.58)
鱗癌 68(64.15) T4 37(34.90)
腺癌 27(25.47) N 4(3.77 ......
化療方案對局部晚期非小細胞肺癌同步放化療的影響分析
中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院 任 華 王綠化 王小震 呂紀馬 周宗玫 歐廣飛 殷蔚伯
Abstract Objective: To retrospectively analyze the effects of different concurrent chemotherapy
regimens on locally advanced non–small-cell lung carcinoma (NSCLC).Methods and Materials: Data
were analyzed from 106 patients pathologically diagnosed as NSCLC (Ⅲa:29,Ⅲb:77) and received
concurrent external beam radiotherapy with various chemotherapy regimens. Analysis was performed
for overall survival, progression-free survival, and toxicity (grade≥2). Results: Paclitaxel based
chemotherapy regimen was delivered in 55 patients (51.9%), whereas 21 patients(19.8%) with
topotecan regimen and 26 patients (24.5%)with PE (cisplatin and etopside) regimen, 4 patients had
other chemotherapy regimens . The median follow-up time for surviving patients was 14.4 months, the
median survival time was 18.6 months, the overall 1-，2- and 3-year survival rate were 72.2%, 41.1%
and 27.5%, respectively. Survival and toxicity analysis were performed in 102 patients which included
paclitaxel , topotecan and PE groups , the median survival time was 16.3 months, 27.3 months and 29.1
months, respectively. The overall survivals of topotecan and PE groups were superior to paclitaxel
based group, but not signifcant (P=0.32). Howerevr, when topotecan and PE group were combined (47
patients) and compared to paclitaxel based regimen group, the median survival was poorer in patients
with paclitaxel based regimen (16.3 months vs 27.3 months), and both in univariate and multivariate
analysis paclitaxel based chemotherapy regimen was significantly associated with poorer survival (P<
0.05). N stage was significant in the Cox multivariate regression model. Paclitaxel based regimen was
associated with more acute radiation pneumonitis, 27.3% versus 10.6%, (P=0.03), less blood toxicity
(16.4% vs 29.8%) (P=0.108) and almost same esophagitis(29.1% vs 34.0%). Conclusions: This
retrospective analysis showed a correlation between concurrent chemotherapy regimens with survival
and toxicity in patients with locally advanced NSCLC. Further study for chemotherapy regimens in
concurrent chemoradiation is needed.
Key Words Non–small-cell lung carcinoma； Radiotherapy； Chemotherapy； Regimen； Treatment
局部晚期非小細胞肺癌占非小細胞肺癌的30%~40%，單純放療5年生存率只有5%~10%[1]
，序貫化放
療與其相比可以提高5年生存率8%~17%[2-4]
，患者預(yù)后仍然不佳。二十世紀后期開始，國外多個Ⅰ-Ⅱ期
臨床試驗顯示同步放化療可取得較為理想的療效[5-9]
，多個研究中心的Ⅲ期臨床研究證實以同步放化療為
主的治療模式可提高局部晚期非小細胞肺癌的生存率[10-15]
，同步放化療已成為局部晚期非小細胞肺癌的
標(biāo)準(zhǔn)治療。目前不同研究中心開展同步治療研究選用的化療方案不一，尚未見到針對同步治療的化療方
案的臨床研究意見。我院自1999年以來開展了的多種化療方案的同步放化療治療局部晚期非小細胞肺癌
的臨床實踐，本文采用隊列研究的方法比較我院1999年4月~2005年10月采用不同化療方案的同步放化療
治療局部晚期非小細胞肺癌的療效及毒性反應(yīng)。
一、 材料與方法
(一) 入組標(biāo)準(zhǔn)
經(jīng)細胞學(xué)或病理證實為非小細胞肺癌的患者，入組時無遠處轉(zhuǎn)移證據(jù)，2002年UICC TNM分期Ⅲ期；
既往無放化療史，治療前血象以及肝腎功能無異常�；颊咦栽附邮苤委煵⒂谥委熐昂炇鸱暖熀突熤橹袊R床腫瘤學(xué)教育專輯 (2007) 203
同意書。
(二) 一般臨床資料
1999年4月~2005年10月，共106例患者入組，其中男93例，女14例，中位年齡57.50歲(26~77歲)。TNM
分期Ⅲa期29例，Ⅲb77例，余詳見表1。
表1 106例患者一般臨床資料
項目 例數(shù)(%) 項目 例數(shù)(%)
KPS 3(2.83，未評價) T 5(4.72，未評價)
≥80 94(88.7) T1 4(3.77)
<80 9(8.49) T2 35(33.02)
病理類型 T3 25(23.58)
鱗癌 68(64.15) T4 37(34.90)
腺癌 27(25.47) N 4(3.77 ......
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