背景与目的 尽管美国国立综合癌症网络推荐同步放化疗为不可手术局部晚期非小细胞肺癌的标准治疗手段,但同步放化疗方案仍有争议,本研究旨在比较适形或调强放疗合并紫杉醇每周三次用法和相同总剂量的每周一次用法治疗局部晚期非小细胞肺癌的优劣,以优选放疗中紫杉醇的最佳给药方案.方法 2006年4月-2009年4月,全国多中心顺序人选符合条件的局部晚期非小细胞肺癌患者,采用随机数字表法将入组患者随机分为两组,放疗要求95%PTV达(60-70) Gy/ ( 30-35)次/(6-7)周.结果 共38例患者人组.每周三次用法组18例,1例治疗结束后1年出现3度放射性肺损伤,后因肺内感染呼吸衰竭死亡,3例患者出现1度-2度放射性肺炎,1例患者出现3度放射性食道炎,12例患者出现1度-2度放射性食道炎,13例患者出现1度-2度白细胞减少;每周一次用法组20例.3例患者出现3度放射性肺炎,3例患者出现2度放射性肺炎,1例患者出现3度放射性食道炎,10例患者出现1度-2度放射性食道炎.1例患者出现4度白细胞减少,14例患者出现1度-3度白细胞减少.两组患者有效率分别为88.8%和50.0%( P=0.026).两组患者1年生存率分别为79%和67% ( P=0.607).结论 适形或调强放疗合并紫杉醇每周三次用法较每周一次用法治疗局部晚期非小细胞肺癌安全、有效.%Background and objective Although the guidelines of the National Comprehensive Cancer Network of USA recommend that the standard therapy for locally advanced non-small cell lung cancer (LANSCLC) is concurrent chemoradiotherapy.There is ongoing controversy about the treatment regimen which combines chemotherapy concurrently with radiotherapy.The aim of this study is to compare weekly usage with triple weekly usage of paclitaxel in concurrent radiochemotherapy for patients with LANSCLC, and to obtain the best paclitaxel regimen in the concurrent radiochemotherapy.Methods From April 2006 to April 2009, some LANSCLC patients in multicenter were randomly divided into weekly usage (45 mg/m2,1 times/week, a total of 270 mg/m2 in six weeks) and triple weekly usage (15 mg/m2, 3 times/week, a total of 270 mg/ m2 in six weeks) group of paclitaxel by a random number table.All patients were treated with 3D radiotherapy, and 95％ planning target volume (PTV) received a prescription dose of (60-70) Gy/(30-35)times/(6-7)weeks, (1.8-2.0) Gy/fraction.Then the side effects, response and overall survival rate were compared between two groups of patients.Results Thirty-eight LANSCLC patients were enrolled.Weekly usage and triple weekly usage group were 20 and 18 patients, respectively.In the triple weekly usage group, the side effects were 12 patients had radiation esophagitis of Ⅰ-Ⅱ degree, 1 patient had radiation esophagitis of Ⅲ degree, 2 patients had radiation pneumonitis of Ⅰ degree, 1 patient had radiation pneumonitis of Ⅱ degree, 1 patient had radiation pneumonitis of Ⅲ degree and died of respiratory failure, 2 patients developed weight loss of Ⅰ degree.In the weekly usage group, the side effects were 11 patients had radiation esophagitis of Ⅰ-Ⅲ degree, 6 patients had radiation pneumonitis of Ⅱ-Ⅲ degree, 2 patients developed weight loss of Ⅰ degree, 6 patients developed leucopenia of Ⅲ-Ⅳ degree.The response rate of two groups was 88.8％ and 50.0％, respectively (P=0.026).1-year survival rate of two groups was 79％ and 67％, respectively (P=0.607).Conclusion Although the preliminary results did not show the merits of survival in triple weekly usage, but preliminary results show that triple weekly usage was more safe and effective than weekly usage of paclitaxel in concurrent radiochemotherapy for patients with LANSCLC.
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