局部晚期非小细胞肺癌同步放化疗中紫杉醇两种用法的多中心、随机对照研究

BACKGROUND AND OBJECTIVE: Although the guidelines of the National Comprehensive Cancer Network of USA recommend that the standard therapy for locally advanced non-small cell lung cancer (LANSCLC) is concurrent chemoradiotherapy. There is ongoing controversy about the treatment regimen which combines chemotherapy concurrently with radiotherapy. The aim of this study is to compare weekly usage with triple weekly usage of paclitaxel in concurrent radiochemotherapy for patients with LANSCLC, and to obtain the best paclitaxel regimen in the concurrent radiochemotherapy. METHODS: From April 2006 to April 2009, some LANSCLC patients in multicenter were randomly divided into weekly usage (45mg/m(2), 1 times/week, a total of 270 mg/m(2) in six weeks) and triple weekly usage (15 mg/m(2), 3 times/week, a total of 270 mg/m(2) in six weeks) group of paclitaxel by a random number table. All patients were treated with 3D radiotherapy, and 95% planning target volume (PTV) received a prescription dose of (60-70) Gy/(30-35)times/(6-7)weeks, (1.8-2.0) Gy/fraction. Then the side effects, response and overall survival rate were compared between two groups of patients. RESULTS: Thirty-eight LANSCLC patients were enrolled. Weekly usage and triple weekly usage group were 20 and 18 patients, respectively. In the triple weekly usage group, the side effects were 12 patients had radiation esophagitis of Ⅰ-Ⅱ degree, 1 patient had radiation esophagitis of Ⅲ degree, 2 patients had radiation pneumonitis of I degree, 1 patient had radiation pneumonitis of Ⅱ degree, 1 patient had radiation pneumonitis of Ⅲ degree and died of respiratory failure, 2 patients developed weight loss of I degree. In the weekly usage group, the side effects were 11 patients had radiation esophagitis of Ⅰ-Ⅲ degree, 6 patients had radiation pneumonitis of Ⅱ-Ⅲ degree, 2 patients developed weight loss of I degree, 6 patients developed leucopenia of Ⅲ-Ⅳ degree. The response rate of two groups was 88.8% and 50.0%, respectively (P=0.026). 1-year survival rate of two groups was 79% and 67%, respectively (P=0.607). CONCLUSION: Although the preliminary results did not show the merits of survival in triple weekly usage, but preliminary results show that triple weekly usage was more safe and effective than weekly usage of paclitaxel in concurrent radiochemotherapy for patients with LANSCLC.