Crvenkova S, Krstevska V
University Radiotherapy and Oncology Clinic, Medical Faculty, Skopje, R. Macedonia.
Prilozi. 2009 Dec;30(2):197-207.
The aim of the study was to compare the survival impact of concurrent versus sequential treatment with radiotherapy and chemotherapy in inoperable stage III non-small cell lung cancer (NSCLC). 85 patients were randomly assigned to one of the two treatment groups. In the sequential group, 45 patients had previously received sequential chemotherapy with 4 cycles of carboplatine and etoposide followed by conformal radiotherapy (RT). In the second concurrent group 40 patients received concomitant chemotherapy of cisplatine and etoposide and conformal RT followed by two cycles of consolidation chemotherapy of carboplatine and etoposide. We described all phases of the conformal three dimensional (3-D) RT. From November 2005 to October 2008, 93 patients were enrolled. Eight patients were not eligible, seven had stage IV and one had pleural effusion. All these were initially considered to have stage IIIB disease. The median survival was 13 months for the patients in the sequential group and 22 months in the concurrent treatment group. The difference was statistically significant (log-rank test p = 0.001). The disease-free survival was 9 months in the sequential group and 17 months in the concurrent treatment group. The difference was statistically significant (log-rank test p = 0.001) The 1- and 2-year survival rates were 73.6% and 39.7% in the concurrent group and 54.9% and 13.7% in the sequential group, respectively (log-rank test, p = 0.0011). Treatment-related toxicities were assessed according the RTOG/EORTC criteria. Acute esophagitis and incidence of neutropenia were higher with the concurrent than with the sequential treatment. Grade 3 esophagitis was characteristic only of concurrent treatment and it was a reason for radiotherapy interruption, but no longer than 7 days. Secondary anaemia was more frequent in the sequential treatment group. The statistical significant differences in survival suggest that concurrent chemotherapy and conformal three-dimensional radiotherapy is the optimal strategy for patients with locally advanced NSCLC.
本研究的目的是比较同步与序贯放化疗对无法手术的Ⅲ期非小细胞肺癌（NSCLC）患者生存的影响。85例患者被随机分配到两个治疗组之一。在序贯组中，45例患者先前接受了4周期卡铂和依托泊苷的序贯化疗，随后进行适形放疗（RT）。在第二个同步组中，40例患者接受顺铂和依托泊苷的同步化疗及适形放疗，随后进行2周期卡铂和依托泊苷的巩固化疗。我们描述了适形三维（3-D）放疗的所有阶段。2005年11月至2008年10月，共纳入93例患者。8例不符合条件，7例为Ⅳ期，1例有胸腔积液。所有这些患者最初均被认为患有ⅢB期疾病。序贯组患者的中位生存期为13个月，同步治疗组为22个月。差异具有统计学意义（对数秩检验p = 0.001）。序贯组的无病生存期为9个月，同步治疗组为17个月。差异具有统计学意义（对数秩检验p = 0.001）。同步组的1年和2年生存率分别为73.6%和39.7%，序贯组分别为54.9%和13.7%（对数秩检验，p = 0.0011）。根据RTOG/EORTC标准评估治疗相关毒性。同步治疗组的急性食管炎和中性粒细胞减少症发生率高于序贯治疗组。3级食管炎仅为同步治疗所特有，是放疗中断的原因，但不超过7天。继发性贫血在序贯治疗组中更为常见。生存方面的统计学显著差异表明，同步化疗和适形三维放疗是局部晚期NSCLC患者的最佳治疗策略。
