| Objective: To compare and analyse the clinical curative，toxicity effects andinfluence factors of concurrent vs sequential chemoradiotherapy used in unresectablestage III NSCLC.Methods: Datas of86patients with unresectable stage III NSCLC who werehospitalized and received combined chemoradiotherapy in Jiangxi Provincial TumorHospital from1/1/2007to12/31/2010were retrospective analysed. The86patientswere divided into two groups: the concurrent chemoradiotherapy group (42patients)and the sequential chemoradiotherapy group (44patients).Observe the patient’sshort-term effects, acute toxicity effects, local progression, distant metastasis anddeaths. Chi-square test was used to compared the differences of basic characteristicsof patients between the two groups,as well as the differences of short-termeffects,acute toxicity effects,rates of local failure and rates of distant metastasisbetween the two groups.Survival rates were calculated by Kaplan-Meier, andLog-Rank test was used to examed the differences of survival rates between the twogroups.Cox proportional hazards regression model was used for multivariate analysis.Results:(1)The response rate of target tumor was much higher in concurrentgroup compared to sequential group,respectively78.6%and56.8%with significantdifference.(2)The median survival time of the concurrent group and sequential groupwere18and14months respectively,and the1-,2-,3-year suirviavl rates of the twogroups were69.0%,36.9%,24.7%vs56.8%,25.6%,12.8%respectively,all differenceswith statistical significance(P=0.039).The median progession-free survival time ofthe two groups were12and11months respectively with no significantdifferences(P=0.0347),and the3-year PFS rates were16.9%and12.2%respectively.(3)The rate of acute grade3-4radiation esophagitis was higher in concurrent thansequential therapy group,26.2%and9.1%respectively (P=0.037).While thedifferences of incidence rate of acute grade3-4radiation pulmonitis in the twotherapy groups were not statistically significant,11.9%and6.8%respectively (P=0.258).The rates of acute grade3-4hematologic toxicities effects and nausea/vomit reaction were also similar between the two groups.(4)Cox regression modelanalysis showed that,PS scores,degree of weight loss，baseline HB level,stage andtreatment modes were independent prognostic factors of the whole group patient’soverall survival rate.(5)Subgroup analysis showed that,only patients with weightloss<5%, IIIA stage or radiotherapy dose60-66Gy had a better3-year survival rateand median survival time with concurrent than sequential therapy(P <0.05), andpatients with age<60years had a benefit tendency of survival by concurrentchemoradiotherapy compared with sequential therapy (P=0.062).For patients with PS0, HB≥120g/L,the3-year survival rate and median survival time were higher withconcurrent than sequential chemoradiotherapy,but the differences had no statisticalsignificance(P>0.05).(6)The rates of total failure in concurrent and sequential groupwere78.6%and84.4%. The rate of local-regional progression were38.1%and47.8%,and the rate of distant metastasis was both50%in the two groups.There wasno significant difference of each type of failure between the two groups.Conclusions:(1)Concurrent chemoradiotherapy was superior to sequentialchemoradiotherapy in unresectable stage III NSCLC with improved short-termeffects,median suirvival time and3-year survival rate.(2)Acute grade3-4radiationesophagitis was significantly increased with concurrent chemoradiotherapy,but couldbe accepted by patients.(3)Compared with sequential chemoradiotherapy,for theNSCLC patients with weight loss<5%, stage IIIA or age<60years,concurrentchemoradiotherapy probably had survival benefits;concurrent therapy withradiotherapy of60-66Gy might also have survival benefits.(4)For the NSCLCpatients with PS1,weight loss≥5%,HB<120g/L,IIIB stage or age≥60years,concurrent chemoradiotherapy probably had no survival benefits,and sequentialchemoradiotherapy was an alternative regimen. |
PDF Full Text Request