[Abstract] Objective EP, DP program plus concurrent radiotherapy treatment of advanced non-small cell lung cancer, the efficacy, toxicity and tolerability observed. Methods 91 patients with locally advanced non-small cell lung cancer patients were randomly divided into two groups: the EP regimen plus concurrent radiotherapy and 46 cases, the the DP regimen plus concurrent radiotherapy 45 cases. The radiotherapy are conventional fractionated irradiation cobalt 60γ line. 0.05）。">EP results of the radiotherapy group the DP of discharge group were 52.2%, 71.1%, but the difference was statistically significant (P> 0.05). Two sets of complete remission rates were 10.9% (5/46), 28.9% (13/45), the difference was statistically significant. The two groups of 1,2-year survival rates were 45.3%, 62.4% and 20.2%, 32.6%. The main side effects were gastrointestinal reactions, severe bone marrow suppression, alopecia, DP group, the majority of patients can be tolerated, no treatment-related deaths. Conclusion program concurrent chemoradiation therapy can be integrated first-line treatment for locally advanced non-small cell lung cancer.
Key words advanced non-small cell lung cancer; chemotherapy; radiotherapy; docetaxel; cisplatin
Clinical Observation of EP, DP Regimen Combined with Radiotherapy in Treatment of Locally Advanced Non small Cell Lung Cancer
ZHANG Hong yun, ZHANG Guo qing
Department of Radiotherapy, LinFen Tumor Hospital, Linfan 041000, ChinaAbstract: Objective To observe the effect and the clinical toxicity between EP, DP regimen combined with concurrent radiotherapy in the treatment of locally advanced non small cell lung cancer (NSCLC). MethodsNinety one patients were randomly assigned into two groups. EP group: EP regimen concurrent radiotherapy for 46 cases, DP group: DP regimen concurrent radiotherapy for 45 cases, radiotherapy are conventional standard fractionation.Results The response rate in EP group and DP group were 52.2%, 0.05).The local complete response rate were 10.9%(5/46),28.9%(13/45) for the patients treated with EP,DP regimen respectively (P<0.05).One year survival rate">71.1% respectively (P> 0.05). The local complete response rate were 10.9% (5/46), 28.9% (13/45) for the patients treated with EP, DP regimen respectively (P <0.05). One year survival rate in EP, DP group were 45.3%, 62.4% respectively. Two year survival rate wrer 20.2% and 32.6%. The major toxicity was gastrointestinal tract reaction, myelosuppression and alopecia and so on. Most of patients tolerate well. Conclusion EP, DP regimen concurrent radiotherapy has good clinical efficacy and safe in the combined therapy of locally advanced NSCLC. They could become the original regimen in locally advanced NSCLC.
Key words: Advanced non small cell lung cancer; Chemotherapy; Radiotherapy; Docetaxel; Cisplatin
80% of lung cancer clinical advanced non-small cell lung cancer (NSCLC), the most diagnosed with advanced stage, unresectable, the therapeutic effect of a single method alone is far from ideal. Our hospital from May 2003 to May 2007, EP, the DP regimen plus concurrent radiotherapy and 91 cases of patients with locally advanced non-small cell lung cancer, and achieved good effect, Reports are summarized as follows.
1 Materials and Methods
1.1 Selection of cases of 91 patients by cytology or histology confirmed the initial treatment of stage Ⅲ NSCLC cases are divided into two groups: EP Sinochem group, 46 cases the DP of group, 45 cases, the two groups were random table The clinical characteristics are shown in Table 1. Gender, age, histological type, staging and other conditions of the two groups were balanced comparable. ZPS Rating: 0 to 2 points.
1.2.1 chemotherapy EP group: relying on and etoposide 100mg/m2, cisplatin 30mg/m2, days 1 to 3 intravenous infusion. DP Group: docetaxel (Qilu Pharmaceutical production: DOC) 75mg/m2 on day 1; cisplatin 30mg/m2 on days 1 to 3 intravenous infusion. Conventional pretreatment dexamethasone 8mg oral docetaxel before treatment, 2 times / day, 3 days. 30 minutes before intravenous intramuscular diphenhydramine 40mg, intravenous cimetidine 400mg, more West his race allergic reactions than paclitaxel was significantly lower, but the clinical conventional medication, prevention taxane allergic reactions. Two kinds of tables clinical data of 191 patients with locally advanced non-small cell lung cancer program three weeks repeated once, systemic chemotherapy at least two cycles. Both groups were supplemented antiemetic, symptomatic and supportive treatment.
1.2.2 radiotherapy cobalt the conventional fractionated 60γ line treatment. The radiation field including the primary tumor, mediastinal and ipsilateral hilar lymph nodes. Press each time 2.0Gy per day, 5 times a week, at doses up to 40Gy reduced field after avoiding the spinal cord continue irradiation, a total of 60 ~ 65Gy.
1.3 Evaluation discharge four weeks after the end of chemotherapy, according to WHO unified standard line efficacy evaluation. 0 ~ Ⅳ toxicity according to WHO criteria.
1.4 efficient statistical methods and the comparison of the incidence of adverse reactions, using χ2 test. P <0.05 was considered statistically significant.
2.1 Recent efficacy shown in Table 2.91 cases patients completed a total of 258 cycles. 0.05）。">Both groups had efficiency was no significant difference (χ 2 = 3.433, P> 0.05). Which two sets of complete remission rate difference was statistically significant (χ 2 = 4.671, P <0.05). Table 291 patients with advanced non-small cell lung cancer compare
2.2 1,2-year survival rate to May 2008, the follow-up time of 5 to 38 months, with a median follow-up time of 18.9 months, which lost to three cases death count. EP 1-year survival rate of the DP group were 45.3%, 62.4%, and the 2-year survival rates were 20.2%, 32.6%. Time to tumor progression (TTP) of 7.3 months, 4.5 months, respectively.
2.3 Adverse reactions are shown in Table 3. 0.05），消化道反应发生率DP组较高，但由于预防性应用止吐药及对症">Radiation esophagitis, radiation pneumonitis, thrombocytopenia and gastrointestinal reactions, the incidence of the difference was not statistically significant (P> 0.05), higher incidence of gastrointestinal reactions DP group, but due to preventive antiemetic and symptomatic processing, can be tolerated. Hair loss, bone marrow suppression difference was statistically significant (P <0.05). One cases of allergic reactions to the DP group, mild symptoms, symptomatic treatment, continue to complete the treatment, another the DP group have two cases of fluid retention, moderate edema of the lower limbs, disappeared within the puffy one week after symptomatic treatment.
Radiochemical comprehensive treatment of locally advanced non-small cell lung cancer is now widely accepted mode of treatment, its therapeutic effect is superior to radiotherapy alone, concurrent chemoradiotherapy is shown in terms of efficacy is superior to sequential and alternating treatment, but at the same time bring The treatment increased complications . EP regimen is commonly used program for the treatment of non-small cell lung cancer in the 1980s, chemotherapy efficiency of about 30%, less toxicity, after the 1990s, the third-generation chemotherapy drugs plus cisplatin or carboplatin, chemotherapy efficiency of up to 40 percent, but chemotherapy seems to have reached a plateau, it is difficult to improve efficacy . For nearly 10 years, the treatment of non-small cell lung cancer in put some progress on the combination of chemotherapy, especially for locally advanced cases, put chemotherapy combination is a better choice . Treatment ideas based on: ① topical treatment with systemic therapy combined; (2) radiotherapy strong anti-G2 phase cells, the specific cycles of chemotherapy drug anti-S phase or M phase of lung cancer cells, on the complementary phase cyclical role; ③ The docetaxel The race, cisplatin to radiotherapy sensitizing effect of strengthening the cytotoxic effects of radiotherapy; ④ put chemotherapy combination can be maintained longer valid . Docetaxel is the third generation of anti-tumor drugs, is now considered the gold standard of the second-line treatment of NSCLC, half synthetic taxane derivatives by stabilizing microtubules, inhibition of microtubule depolymerization induced microtubule bundle arrangement abnormal single-agent chemotherapy treatment efficiency of 16% to 22% of lung cancer deaths,. Approved by the FDA in 2002 as a first-line drug therapy NSCLC . The Chen et  reported that radiation synchronization Dorsey him race once a week, RR81.1. Chengwen Fang et al  reported ifosfamide, doxorubicin and cisplatin synchronous chemoradiotherapy efficient than sequential group. Table 3 between the two groups chemoradiotherapy reaction
Our results of EP, DP two groups have the efficiency difference was not statistically significant, but the complete remission rate of DP group than in the EP group, the difference was statistically significant (P <0.05). And 2-year survival rate of DP group were higher than the EP group, and longer time to tumor progression. The higher complete remission rate, may all newly diagnosed cases, in combination with radiotherapy-related. Adverse reactions the DP groups alopecia, bone marrow suppression heavier than the EP group tolerated treatment with colony-stimulating factor support. Radiation esophagitis, the incidence of radiation pneumonitis was no significant difference between the two groups, the control of symptoms after symptomatic treatment. In short, the two programs sync put the efficacy of chemotherapy for advanced non-small cell lung cancer have better the DP technology put the complete remission rate, survival rate is higher than the EP group, increased side effects, but can be tolerated, can be used as a clinical first-line choice. EP of toxicity of radiotherapy group less efficient DP group approach, suggesting that in the poor part of the physical condition of PS 2 patients tolerated, and the two drugs cheap, the cost of treatment is a third-generation chemotherapy 1/4 to 1/6, from drugs economics consider, is still a choice of commonly used programs, especially in cases of poor economic conditions applicable . Due to the short observation period, the long-term efficacy and survival of two programs for further study.