Austin-Ludwig Oncology Unit, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, Australia; Ludwig Institute for Cancer Research, Olivia Newton-John Cancer & Wellness Centre, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
Cancer Med. 2013 Dec;2(6):916-24. doi: 10.1002/cam4.142. Epub 2013 Oct 16.
Concurrent chemoradiotherapy (CCRT) has become the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). The comparative merits of two widely used regimens: carboplatin/paclitaxel (PC) and cisplatin/etoposide (PE), each with concurrent radiotherapy, remain largely undefined. Records for consecutive patients with stage III NSCLC treated with PC or PE and ≥60 Gy chest radiotherapy between 2000 and 2011 were reviewed for outcomes and toxicity. Survival was estimated using the Kaplan-Meier method and Cox modeling with the Wald test. Comparison across groups was done using the student's t and chi-squared tests. Seventy-five (PC: 44, PE: 31) patients were analyzed. PC patients were older (median 71 vs. 63 years; P = 0.0006). Other characteristics were comparable between groups. With PE, there was significantly increased grade ≥3 neutropenia (39% vs. 14%, P = 0.024) and thrombocytopenia (10% vs. 0%, P = 0.039). Radiation pneumonitis was more common with PC (66% vs. 38%, P = 0.033). Five treatment-related deaths occurred (PC: 3 vs. PE: 2, P = 1.000). With a median follow-up of 51.6 months, there were no significant differences in relapse-free survival (median PC 12.0 vs. PE 11.5 months, P = 0.700) or overall survival (median PC 20.7 vs. PE 13.7 months; P = 0.989). In multivariate analyses, no factors predicted for improved survival for either regimen. PC was more likely to be used in elderly patients. Despite this, PC resulted in significantly less hematological toxicity but achieved similar survival outcomes as PE. PC is an acceptable CCRT regimen, especially in older patients with multiple comorbidities.
同期放化疗（CCRT）已成为不可切除的 III 期非小细胞肺癌（NSCLC）患者的标准治疗方法。两种广泛使用的方案（卡铂/紫杉醇[PC]和顺铂/依托泊苷[PE]）的比较优势在很大程度上仍未得到明确。对 2000 年至 2011 年间接受 PC 或 PE 治疗并接受≥60Gy 胸部放疗的连续 III 期 NSCLC 患者的记录进行了回顾，以评估结局和毒性。采用 Kaplan-Meier 方法和 Cox 模型进行生存估计，并采用 Wald 检验进行 Cox 模型检验。使用学生 t 检验和卡方检验进行组间比较。分析了 75 例（PC：44 例，PE：31 例）患者。PC 患者年龄较大（中位数 71 岁比 63 岁；P=0.0006）。两组间其他特征相似。PE 组中，≥3 级中性粒细胞减少症（39%比 14%，P=0.024）和血小板减少症（10%比 0%，P=0.039）的发生率显著增加。PC 组放射性肺炎更为常见（66%比 38%，P=0.033）。5 例治疗相关死亡（PC：3 例，PE：2 例，P=1.000）。中位随访 51.6 个月时，无复发生存率（PC 组 12.0 个月比 PE 组 11.5 个月，P=0.700）或总生存率（PC 组 20.7 个月比 PE 组 13.7 个月，P=0.989）无显著差异。多变量分析显示，两种方案均无预测生存改善的因素。PC 更可能用于老年患者。尽管如此，PC 导致的血液学毒性显著减少，但与 PE 相比，PC 达到了相似的生存结果。PC 是一种可接受的 CCRT 方案，尤其是在有多种合并症的老年患者中。
