CAJ | 학술논문

目的探讨不同化疗方案对局部晚期非小细胞肺癌(NSCLC)同步放化疗疗效的影响.方法收集接受同步放化疗的106例局部晚期NSCLC患者(Ⅲa期29例,Ⅲb期77例)的临床病例资料,其中55例患者接受含紫杉醇方案、21例患者接受拓扑替康方案、26例患者接受PE方案[依托泊甙(VP-16)+顺铂(DDP)]、4例患者接受其他方案的同步放化疗.采用回顾性队列研究的方法,分析不同化疗方案对患者总生存期和毒副反应发生率的影响.结果全组患者的中位生存时间为18.6个月,1、2、3年总生存率分别为72.2%、41.1%和27.5%.接受含紫杉醇方案、拓扑替康方案和PE方案同步放化疗患者的中位生存时间分别为16.3、27.3和29.1个月,差异无统计学意义(P=0.32).含紫杉醇方案组患者的中位生存时间(16.3个月)明显短于合并的拓扑替康-PE方案组(27.3个月,P<0.05).多因素分析显示,化疗方案(含紫杉醇方案和拓扑替康-PE方案)和N分期对患者的总生存期有显著影响(均P<0.05).含紫杉醇方案组急性放射性肺炎(2～4级)的发生率(27.3%)明显高于拓扑替康-PE方案组(10.6%,P=0.03),但两组间血液学毒性(3～4级)和放射性食管炎(2～4级)的发生率差异均无统计学意义(16.4%∶29.8%,P=0.11;29.1%∶34.0%,P=0.59).结论局部晚期NSCLC同步放化疗中的不同化疗方案与患者的总生存期和放射性肺炎的发生率相关.
목적 탐토불동화료방안대국부만기비소세포폐암(NSCLC)동보방화료료효적영향.방법 수집접수동보방화료적106례국부만기NSCLC환자(Ⅲa기29례,Ⅲb기77례)적림상병례자료,기중55례환자접수함자삼순방안、21례환자접수탁복체강방안、26례환자접수PE방안[의탁박대(VP-16)+순박(DDP)]、4례환자접수기타방안적동보방화료.채용회고성대렬연구적방법,분석불동화료방안대환자총생존기화독부반응발생솔적영향.결과 전조환자적중위생존시간위18.6개월,1、2、3년총생존솔분별위72.2%、41.1%화27.5%.접수함자삼순방안、탁복체강방안화PE방안동보방화료환자적중위생존시간분별위16.3、27.3화29.1개월,차이무통계학의의(P=0.32).함자삼순방안조환자적중위생존시간(16.3개월)명현단우합병적탁복체강-PE방안조(27.3개월,P<0.05).다인소분석현시,화료방안(함자삼순방안화탁복체강-PE방안)화N분기대환자적총생존기유현저영향(균P<0.05).함자삼순방안조급성방사성폐염(2～4급)적발생솔(27.3%)명현고우탁복체강-PE방안조(10.6%,P=0.03),단량조간혈액학독성(3～4급)화방사성식관염(2～4급)적발생솔차이균무통계학의의(16.4%∶29.8%,P=0.11;29.1%∶34.0%,P=0.59).결론 국부만기NSCLC동보방화료중적불동화료방안여환자적총생존기화방사성폐염적발생솔상관.
Objective To retrospectively analyze the effects of different chemotherapy regimens for concurrent chemoradiation on locally advanced non-small cell lung cancer (NSCLC). Methods The data chemotherapy regimens for concurrent chemoradiotherapy, were retrospectively analyzed. Paclitaxel-based chemotherapy regimen was administered in 55 patients, topotecan regimen in 21 patients, PE (cisplatin and etopside) regimen in 26 patients, and other regimens in the remaining 4 patients. The effect of different chemotherapy regimens on overall survival and toxicity was analyzed. Results The median survival time was 18.6 months, and the overall 1-and 3-year survival rates were 72.2% and 27.5%, respectively. The median survival time of 102 patients treated with paclitaxel-containing, topotecan-containing or PE regimens was 16.3, 27.3 and 29.1 months, respectively. The overall survival times of topetecan and PE groups were superior to that of paclitaxol-based group, but not significantly different (P=0.32). Both univariate and multivariate analysis showed that paclitaxol-based chemotherapy regimen was significantly associated with a poorer survival (P<0.05). N stage was another significant prognostic factor determined by COX multivariate regression model. Compared with the other regimens (10.6%), paclitaxel-based regimen (27.3%) had more acute radiation pneumonitis (grade≥2, P=0.03), but no significant differences were observed in blood toxicity and esophagitis. Conclusion There is a correlation between different chemotherapy regimens for concurrent ehemoradiotherapy and the overall survival and acute radiation pneumonitis in patients with locally advanced NSCLC.