Objective To compare the therapeutic efficacy and toxicities of pemetrexed or paclitaxel combined with concurrent ra-diotherapy for elderly patients with locally advanced lung adenocarcinoma. Methods A total of 92 elderly patients who were diagnosed by histology with stage ⅢA or ⅢB local advanced lung adenocarcinoma were randomized into the research group (n=46) and the control group (n=46). Patients in the research group were given pemetrexed 500 mg·m-2, repeated every 3~4 weeks for 2 cycles. Those in control group were given paclitaxel 50 mg·m-2, repeated once a week for 6 ~7 cycles. All patients were treated with concurrent chemoradiotherapy from May 2012 to December 2013 using three dimensional conformal radiotherapy (3D-CRT) with a total dose of 60 ~ 66 Gy, five times a week, for 6 ~ 7 weeks. Results The total effective rates (CR+PR) of the research group and the control group were respectively 78.26% and 67.39% (P>0.05). The median progression-free survivals were 12.8 and 11.2 months, respectively. One year overall survival was respec-tively 61.8% and 56.5%. There was no significant difference between the two groups (P>0.05). However, the incidences of neutropenia and alopecia in the research group were lower than those of the control group (P<0.05). Yet there was no significant difference between the two groups in other adverse reactions such as nausea, vomiting, hemoglobin decrease, thrombocytopenia, radiation induced-esophagitis and ra-diation induced-pneumonitis (P>0.05). Conclusion Pemetrexed or paclitaxel with concurrent chemoradiotherapy was highly effective and well tolerated in the treatment of elderly patients with locally advanced lung adenocarcinoma, but pemetrexed had lighter adverse reactions than paclitaxel. Pemetrexed with concurrent chemoradiotherapy could be worthy of further clinical investigation and application.%目的：比较培美曲塞或紫杉醇联合同期放化疗在局部晚期老年肺腺癌患者治疗中的疗效及毒性反应。方法选取经组织学确诊的Ⅲ A 或Ⅲ B 期老年肺腺癌患者92例，随机分为研究组（培美曲塞500 mg·m-2/次/q3-4w，共2周期）和对照组（紫杉醇50 mg·m-2/次/q4w，共6~7周期），每组46例，采用三维适形放射放疗，DT 60~66 Gy，每周5次，共治疗6-7周。结果研究组患者的治疗总有效率为78.26％，与对照组（67.39％）比较，差异无统计学意义（P>0.05）；研究组和对照组的中位无进展生存期分别为12.8个月和11.2个月，1年总生存率分别为61.8％和56.5％，两组 OS 比较，差异无统计学意义（P>0.05）；研究组患者的中性粒细胞减少及脱发的发生率较对照组低（P<0.05），而两组恶心呕吐、血红蛋白减少及放射性肺炎等不良反应发生率的差异无统计学意义（P>0.05）。结论应用培美曲塞或紫杉醇同期放化疗治疗局部晚期老年肺腺癌患者的疗效均较好，毒副反应可耐受，但培美曲塞方案的不良反应较轻，值得临床推广。
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