摘要目的 探讨放化疗不同联合模式治疗非小细胞肺癌(NSCLC)患者的疗效、不良反应,研究影响其预后的各种因素.方法 将151例经病理确诊的NSCLC患者按治疗模式不同分为3组,同步放化疗组(43例)、序贯放化疗组(49例)及单纯化疗组(59例),进行回顾性分析,评价疗效及不良反应,并分析预后因素.结果 同步放化组、序贯放化组及单纯化疗组有效率(CR+PR)分别为81.4%、73.5%、39.0%,中位生存时间分别为26、12和11个月,1年总生存率分别为80.2%、47.1%及45.6%,2年生存率分别为58.2%、38.5%及24.4%,3年生存率分别为32.7%、27.5%及0;3组不良反应主要为骨髓抑制反应,对于Ⅲ～Ⅳ级白细胞,同步放化组较单纯化疗组及序贯放化组下降明显(P＜0.05);而放射性食管炎及放射性肺损伤,同步放化疗组及序贯放化疗组之间差异无统计学意义;影响NSCLC预后的主要因素有年龄、PS评分、临床分期、治疗手段.结论 同期放化疗在提高中位生存时间及生存率方面优于序贯放化疗,尤其优于单纯化疗,且不良反应可以耐受.年龄、PS评分、临床分期、治疗手段对NSCLC患者生存率有影响.

abstractsObjective To explore the curative effects,prognostic factors,and adverse reactions of different treatment modalities of chemotherapy in patients with non-small cell lung cancer (NSCLC).Methods151 NSCLC patients were randomly assigned into 3 groups to undergo concurrent chemoradiotherapy ( n = 43 ) ,sequential chemo-radiotherapy ( n = 49 ) ,or pure chemotherapy (n = 59).The clinical data were analyzed.ResultsThe short-term effective rates of the concurrent and sequential chemo-radiotherapy groups were 81.4% and 73.5% respectively with no significantly difference between them,but both significantly higher than that of the pure chemotherapy group ( 39.0% ,both P ＜ 0.05 ).The mortality of the concurrent cherno-radiation group was 53.5% ,significantly lower than those of the sequential chemo-radiotherapy and pure chemotherapy groups (67.3% and 67.8% respectively,both P ＜0.05).The median survival time of the concurrent chemo-radiotherapy group was 26 months,significantly longer than those of the sequential chemo-radiotherapy and pure chemotherapy groups ( 12 and 11 months respectively,both P ＜ 0.05).The l-year survival rates of the 3 groups were 80.2% ,47.1%,and 45.6%.The 2-year survival rates were 58.2% ,38.5% ,and 24.4% ,and the 3-year survival rates were 32.7% ,27.5% ,and 0,respectively.The white blood cell decrease rates of the grades Ⅲ～Ⅳ of the concurrent chemo-radiotherapy group were significantly higher than those of the other 2 groups (both P ＜0.05 ).There were no significant differences in the rates of radiation esophagitis and radiation pneumonitis between the concurrent and sequential chemo-radiotherapy groups.Age,performance status score,clinical staging,and treatment modality were the 4 influencing factors in the prognosis of NSCLC ( all P ＜ 0.05 ).Conclusion Relatively safe with tolerable adverse reactions,concurrent chemo-radiotherapy is superior to sequential chemo-radiotherapy,particularly to pure chemotherapy,in increase of median survival time and survival rate in treatment of NSCLC.Age,PS,clinical staging and therapy method are independent indicators influencing the prognosis.