目的 探讨在放化疗同步治疗局部晚期非小细胞肺癌(NSCLC)中不同时间进行放疗对治疗疗效及安全性的影响.方法 将60例局部晚期NSCLC患者随机分为4组,每组15例；所有患者均接受化疗,具体为:紫杉醇120mg/m2静滴,d1、d8；顺铂75 ～ 80mg/m2静滴,d1.21天为1周期,共化疗4个周期.4组分别于化疗1、2、3、4个周期完成后进行同步放疗,具体为:1.8 ～ 2.0Gy/f,每天1次,每周5次,总照射剂量为60Gy.观察各组的疗效及不良反应.结果 于化疗1、2、3、4个周期完成后分别行放疗的4组患者有效率分别为92.3％、71.4％、60.0％和46.7％.主要不良反应为放射性食管炎、骨髓抑制、乏力、脱发等.化疗1个周期结束后联合放疗组的3～4级不良反应发生率高于其他3组,且分别与化疗第3个和第4个周期结束联合放疗组比较,差异均有统计学意义(P＜0.05).结论 化疗早期同步联合放疗治疗晚期NSCLC的有效率较高,但3～4级不良反应发生率亦较高,临床上需酌情制定治疗方案.%Objective To explore the efficacy and safety of concurrent chemoradiotherapy with different timing of radiotherapy for locally advanced non-small cell lung cancer (NSCLC). Methods Sixty NSCLC patients were randomly divided into four groups. All the patients received chemotherapy first(paclitaxel 120mg/m iv d1, d8; cisplatin 75-80mg/m2 iv d1). Twenty-one days was a cycle, and 4 cycles were applied. And then combined with radiotherapy(1. 8-2. 0Gy/f,once per day,five times per week,DT 60Gy) in the treatment after the first cycle (group A) , the second cycle (group B) , the third cycle (group C) and the fourth cycle (group D) respectively. The efficacy and side effects were observed among four groups. Results The efficacy of the four groups was 92. 3% , 71.4% , 60.0% and 46. 7%. The main side effects were radioactive esophagitis, myelosuppression, fatigue and alopecia. The incidence rate of grade 3-4- side effects in group A was higher than those of other groups, and had significant difference compared with group C and group D. Conclusion Radiotherapy combined with chemotherapy at early stage can achieve better effect companied by higher side effects in the treatment of locally advanced NSCLC. The therapeutic regimen should be considered in clinic.
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