[III期非小细胞肺癌患者先行每周一次紫杉醇诱导化疗，随后进行三维适形放疗并同步每周一次紫杉醇治疗的初步结果]

[Initial outcome of induction chemotherapy with weekly paclitaxel followed by three-dimensional conformal radiotherapy and concurrent weekly paclitaxel for stage III non-small cell lung cancer].

作者信息

Wang Wei-Hua, Bao Yong, Chen Ming, Zhang Li, Li Kai-Xin, Xu Guang-Chuan, Deng Xiao-Wu, Lu Tai-Xiang, Cui Nian-Ji

机构信息

State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China.

出版信息

Ai Zheng. 2006 Oct;25(10):1279-83.

PMID:17059776

Abstract

BACKGROUND & OBJECTIVE: The efficacy of radiotherapy alone on locally advanced non-small cell lung cancer (NSCLC) is poor. Although the combined modality of chemoradiotherapy and dose-escalation of radiotherapy have been the main trends, the optimal modality still remains unknown. This study was to evaluate the toxicity and efficacy of induction chemotherapy (ICT) followed by three-dimensional conformal radiotherapy (3D CRT) and concurrent weekly paclitaxel on unresectable NSCLC.

METHODS

Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin (AUC=5-6, d1) combined with paclitaxel (175 mg/m(2), d1), then followed by weekly paclitaxel (40 mg/m(2)) and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 < or =31% and spinal cord dose < or =50 Gy.

RESULTS

Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild (16/31): all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious (29/31, grade 3 in 21). Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grade 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grade 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months.

CONCLUSIONS

The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

摘要

背景与目的

单纯放疗对局部晚期非小细胞肺癌（NSCLC）疗效欠佳。尽管放化疗联合及放疗剂量递增一直是主要趋势，但最佳治疗模式仍不明确。本研究旨在评估诱导化疗（ICT）序贯三维适形放疗（3D CRT）及每周同步紫杉醇治疗不可切除NSCLC的毒性及疗效。

方法

选择条件适宜的Ⅲ期NSCLC患者，给予2至4周期卡铂（AUC = 5 - 6，第1天）联合紫杉醇（175 mg/m²，第1天）化疗，随后每周给予紫杉醇（40 mg/m²），并在3至4周内行同步3D CRT。在V20≤31%且脊髓剂量≤50 Gy的条件下，尽可能给予高处方剂量。

结果

共纳入31例患者。ICT耐受性良好。同步放化疗期间，3例患者因严重肺部及心脏毒性提前终止治疗；2例患者因疲劳分别延迟7天和12天。骨髓抑制较轻（16/31）：除1例为3级外，其余均为1 - 2级。淋巴细胞减少更明显（29/31，21例为3级）。3例患者发生3级放射性食管炎，2例发生3 - 4级放射性肺炎。2例发生3级食管狭窄。未观察到3 - 4级肺纤维化。总有效率为74.1%。1年、2年、3年总生存率分别为74.2%、41.9%、34.6%，中位生存时间为18.5个月。1年、2年、3年局部无进展生存率分别为64.5%、32.3%、20.5%，中位局部无进展生存时间为14.3个月。