CAJ | 학술논문

目的：比较放化同期治疗和放化序贯治疗对局部晚期非小细胞肺癌血浆中 MGMT 的影响。方法：2010年1月至2012年12月，64例经病理确诊的Ⅱb 至Ⅲb 期非小细胞肺癌患者，随机分成放化同期治疗（A组）和放化序贯治疗（B 组）两组。A 组采用三维适形放疗及同期每周 TC 方案化疗后序贯 TC 方案化疗2个周期。B 组先接受三维适形放疗后序贯 TC 方案化疗4个周期。在放射治疗前、放疗开始一个月和治疗后（两组均完成四个周期化疗后）采用巢式甲基化特异性 PCR 方法检测 MGMT 基因的甲基化状态。比较两组 MGMT 基因甲基化阳性率的动态变化情况。结果：A、B 两组缓解率分别为90.6%和68.8%；A 组近期治疗有效率明显优于 B 组（ P =0.0296）。A 组和 B 组的中位疾病进展时间为8.8个月（3-22个月）和7.3个月（2.8-21个月）（P =0.4635）。A、B 两组1年生存率分别为74.1%、72.4%；2年生存率为46.8%、45.2%（P ﹥0.05）。在放射治疗前，A 组和 B 组的 MGMT 基因甲基化阳性率分别为31.3%（10/32）和34.4%（11/32），无显著性差异（P =0.7901）；放疗开始1个月甲基化阳性率分别为15.6%（5/32）和37.5%（12/32），有显著性差异（P =0.0476）；治疗后甲基化阳性率分别为9.4%（3/32）和21.9%（7/32），无显著性差异（P =0.1685）。治疗前后，A 组 MGMT 基因甲基化阳性率显著下降（P =0.0296）；B 组有下降趋势但无显著差异。结论：放化同期治疗较序贯治疗能够有效降低局部晚期肺癌血浆中 MGMT 基因异常甲基化，提示同期化疗能够抑制肿瘤放疗过程中放疗诱发的肿瘤再修复。
목적：비교방화동기치료화방화서관치료대국부만기비소세포폐암혈장중 MGMT 적영향。방법：2010년1월지2012년12월，64례경병리학진적Ⅱb 지Ⅲb 기비소세포폐암환자，수궤분성방화동기치료（A조）화방화서관치료（B 조）량조。A 조채용삼유괄형방료급동기매주 TC 방안화료후서관 TC 방안화료2개주기。B 조선접수삼유괄형방료후서관 TC 방안화료4개주기。재방사치료전、방료개시일개월화치료후（량조균완성사개주기화료후）채용소식갑기화특이성 PCR 방법검측 MGMT 기인적갑기화상태。비교량조 MGMT 기인갑기화양성솔적동태변화정황。결과：A、B 량조완해솔분별위90.6%화68.8%；A 조근기치료유효솔명현우우 B 조（ P =0.0296）。A 조화 B 조적중위질병진전시간위8.8개월（3-22개월）화7.3개월（2.8-21개월）（P =0.4635）。A、B 량조1년생존솔분별위74.1%、72.4%；2년생존솔위46.8%、45.2%（P ﹥0.05）。재방사치료전，A 조화 B 조적 MGMT 기인갑기화양성솔분별위31.3%（10/32）화34.4%（11/32），무현저성차이（P =0.7901）；방료개시1개월갑기화양성솔분별위15.6%（5/32）화37.5%（12/32），유현저성차이（P =0.0476）；치료후갑기화양성솔분별위9.4%（3/32）화21.9%（7/32），무현저성차이（P =0.1685）。치료전후，A 조 MGMT 기인갑기화양성솔현저하강（P =0.0296）；B 조유하강추세단무현저차이。결론：방화동기치료교서관치료능구유효강저국부만기폐암혈장중 MGMT 기인이상갑기화，제시동기화료능구억제종류방료과정중방료유발적종류재수복。
To compare effect of concurrent chemoradiotherapy and sequential therapy on plasma MG-MT in local advanced non small cell lung cancer(NSCLC). Methods:From 2010 January to 2012 December,64 Ⅱb and Ⅲb stage patients with pathologically confirmed non small cell lung cancer,were divided randomly into concurrent chemoradiotherapy group(group A)and sequential therapy group(group B). Group A was treated with three - dimen-sional conformal radiotherapy and concurrent chemotherapy with weekly TC,then sequential TC 2 cycles. Group B re-ceived 4 cycles'TC regimen chemotherapy after three - dimensional conformal radiotherapy. Nested methylation specif-ic PCR(nMSP)was used to detect plasma MGMT methylation of patients from preradiotherapy,radiotherapy in one month to post - treatment. Compare the dynamic changes of the MGMT methylation positive rate. Results:The remis-sion rates in groups A,B were 90. 6% and 68. 8% ,the effective rate of treatmen in group A was better than that of B (P = 0. 0296). The median TTP was 8. 8 months(3 - 22 months)in group A and 7. 3months(2. 8 - 21 months)in group B(P = 0. 4635). 1 - year overall survival rates were 74. 1% ,72. 4% respectively in group A and B,2 - year o-verall survival rates were 46. 8% ,45. 2%(P ﹥ 0. 05). The MGMT methylation positive rates of A group and B were 31. 3%(10 / 32)and 34. 4%(11 / 32),no significant difference(P = 0. 7901)before radiotherapy;were 15. 6%(5 /32)and 37. 5%(12 / 32)radiotherapy in one month,significant difference( P = 0 . 0476 )and after treatment was 9. 4%(3 / 32)and 21. 9%(7 / 32),no significant difference(P = 0. 1685). Before and after the treatment,the MGMT methylation positive rates in group A decreased significantly(P = 0. 0296). Group B had no significant difference ex-cept the decline trend. Conclusion:Concurrent chemoradiotherapy was more effective than the sequential therapy in reducing plasma MGMT methylation of locally advanced NSCLC. Concurrent chemotherapy can inhibit the radiation -induced repair of DNA damage in patients in the process of tumor radiotherapy.