ATRCTRI, Bikaner/Rajasthan, India.
VMMC, Delhi, India.
Gulf J Oncolog. 2021 Sep;1(37):62-69.
The standard treatment for unresectable stage III non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy. This study was undertaken to evaluate whether induction chemotherapy along with concurrent chemoradiotherapy would result in better tumor control, improved symptom control and any variation in toxicity as compared to concurrent chemoradiotherapy alone.
Between February 2015 to September 2016, 25 patients each were randomized to control group, in which they received concurrent chemoradiotherapy with weekly cisplatin 40 mg/m2 intravenous, during chest radiotherapy of 66Gy in 33 fractions for 6.5 weeks, and study group, in which patients received three cycles of induction chemotherapy with Cisplatin 75 mg/m2and Paclitaxel 175 mg/m2administered every 21 days followed by identical chemoradiotherapy.
The two groups of patients (with induction vs. without induction chemotherapy) were similar in age, performance status, histology, grade, and stage. At 6thmonth follow-up, complete response was seen in 6 patients in control arm and 7 patients in study arm (?2 = 1.603, p = 0.205) and partial response was seen in 13 and 12 patients in control and study arms respectively (?2 = 1.932, p = 0.165). Symptom control of cough, hemoptysis, chest pain and dyspnoea were also similar in both groups.
In our study, no difference in treatment outcome with respect to the two groups was observed, which was similar to studies which have been conducted previously. Radiation is a good modality for symptom control of cough, hemoptysis, chest pain and dyspnoea. In toxicities, pneumonitis and hematological toxicity was slightly higher in study group even at 6th month follow up.
Slight increase in toxicity with no added benefit in locoregional tumor control and symptom regression, was seen in patients receiving induction chemotherapy followed by chemoradiotherapy. Concurrent chemoradiotherapy alone can thus be used as only modality of treatment in unresectable stage III NSCLC.
不能切除的 III 期非小细胞肺癌（NSCLC）的标准治疗是同步放化疗。本研究旨在评估诱导化疗联合同步放化疗是否比单纯同步放化疗在肿瘤控制、症状控制改善和毒性变化方面更有优势。
2015 年 2 月至 2016 年 9 月，将 25 例患者随机分为对照组和研究组，每组各 25 例。对照组接受每周 40mg/m2 顺铂静脉注射联合胸部放疗 66Gy（33 次），共 6.5 周；研究组接受 3 个周期的顺铂 75mg/m2 和紫杉醇 175mg/m2 诱导化疗，每 21 天 1 次，随后进行相同的放化疗。
两组患者（诱导化疗组和无诱导化疗组）在年龄、体力状况、组织学、分级和分期方面相似。在 6 个月的随访中，对照组有 6 例完全缓解，研究组有 7 例完全缓解（?2=1.603，p=0.205）；对照组和研究组部分缓解的患者分别为 13 例和 12 例（?2=1.932，p=0.165）。两组咳嗽、咯血、胸痛和呼吸困难的症状控制也相似。
在我们的研究中，两组患者的治疗结果没有差异，这与之前的研究相似。放射治疗是控制咳嗽、咯血、胸痛和呼吸困难等症状的有效方法。在毒性方面，即使在 6 个月的随访时，研究组的肺炎和血液学毒性也略高。
在接受诱导化疗联合放化疗的患者中，毒性略有增加，但局部肿瘤控制和症状缓解无额外获益。因此，不能切除的 III 期 NSCLC 患者可单独采用同步放化疗作为治疗方法。
