Comparison of Weekly Vinorelbine and Weekly Docetaxel, Each with Cisplatin, for Locally Advanced Non-Small Cell Lung Cancer in Patients with Concurrent Chemoradiotherapy

在局部後期非肺小細胞癌病人接受同步化學放射治療時，比較每週vinorelbine和docetaxel加上cisplatin之差異

李忠恕(Chung-Shu Lee) ； 陳志弘(Chih-Hung Chen) ； 高國晉(Kuo-Chin Kao) ； 林信吟(Shinn-Yn Lin) ； 邱立忠(Li-Chung Chiu) ； 劉劍英(Chien-Ying Liu) ； 陳濘宏(Ning-Hung Chen) ； 黃崇旂(Chung-Chi Huang) ； 蔡熒煌(Ying-Huang Tsai) ； 楊政達(Cheng-Ta Yang)

《胸腔醫學》 28卷5期 (2013/10) Pp. 260-269

摘要

前言：同步使用化學治療和放射治療是治療局部後期非肺小細胞癌之標準方法，在亞洲此方法的成效結果並不充足詳細。這個回溯性研究作了同步放射治療和每週化學治療於兩種不同化學治療成分（cisplatin併vinorelbine或cisplatin併docetaxel）的效力和毒性比較。方法：這個研究收集了95位局部後期（stage IIIA or IIIB）非肺小細胞肺癌病人接受了同步放射治療和每週化學治療（cisplatin併vinorelbine或cisplatin併docetaxel）。我們記錄下病人基本背景數據，病理切片結果，治療副作用的資料，同時利用Chi-Square test、Kaplan-Meier survival curve和Cox regression來分析。結果：這兩組（vinorelbine組和docetaxel組）病人的基本資料除了分期（stage）比例有差別外，其餘是相似的。在vinorelbine組和docetaxel組中，疾病控制程度分別為72.9% versus 56%及治療反應為45.8% versus 51.1%。在stage IIIA病人裡，vinorelbine組8個病人中有1個可以接受完全切除手術（12.5%），docetaxel組則是18位病人中有7位可接受完全切除（38.9%）。全部的病人（含接受手術者），vinorelbine組和docetaxel 組的中位存活數分別為15.6 months versus 22.1 months。白血球低下的發生率在vinorelbine組是比較高的（33.3% versus 4.3%）。治療期間有4個病人因敗血症而死亡，其中1個在vinorelbine組，另3個在docetaxel組。結論：這篇研究顯示在局部後期非肺小細胞癌病人中同步放射治療和每週化學治療（cisplatin併vinorelbine 或cisplatin併docetaxel）是安全且有效的。而未來在這類病人的治療成效上，仍需進ㄧ步前瞻性研究。

關鍵字

非肺小細胞癌 ； 同步放射治療和化學治療 ； 存活率

並列摘要

Background: Concurrent chemoradiotherapy (CCRT) is 1 of the standard treatments for locally advanced non-small cell lung cancer (NSCLC) patients. The aim of the present study was to evaluate and compare the efficacy and toxicities of weekly vinorelbine and weekly docetaxel plus cisplatin for locally advanced stage III NSCLC patients with CCRT.Patients and Methods: We performed a retrospective review of locally advanced stage III NSCLC patients in a tertiary referral medical center between January 2003 and December 2009. Patients with histologically and/or cytologically confirmed NSCLC with inoperable stage IIIA or IIIB disease who underwent CCRT with a regimen of weekly cisplatin 20 mg/m^2 combined with weekly vinorelbine 20 mg/m^2 or docetaxel 20 mg/m^2 were included. The scheduled dose of thoracic irradiation was 60 Gy in 30 fractions. The collected data included general information, stage, histological types and performance status. Treatment response, including response rate, time to disease progression, survival time and toxicity, was compared in both groups.Results: Ninety-five patients were enrolled for analysis; 26 (27.4%) had stage IIIA and 69 (72.6%) had stage IIIB NSCLC. All clinical characteristics, except stages, were identical in the 2 groups. The portion of stage IIIB patients was significantly higher in the vinorelbine group than that in the docetaxel group (83.3% versus 61.7%, p=0.018). The disease control rates and response rates of the vinorelbine and docetaxel groups were 72.9% and 74.5%, and 45.8% and 51.1%, respectively. One of 8 stage IIIA patients (12.5%) in the vinorelbine group and 7 of 18 stage IIIA patients (38.9%) in the docetaxel group were down-staged and subsequently received surgical resection for residual tumors. The median survival time of the patients in both groups was not significantly different (15.6 months versus 22.1 months; p=0.07). The incidence of leukopenia was higher in the vinorelbine group (33.3%) than in the docetaxel group (4.3%). We noted that 39.6% of patients in the vinorelbine group and 68.1% in the docetaxel group completed 6 cycles of chemotherapy, respectively. There were 4 toxic deaths due to sepsis during the treatment period, 1 in the vinorelbine group and 3 in the docetaxel group.Conclusions: CCRT with a regimen of weekly vinorelbine plus cisplatin or weekly docetaxel plus cisplatin may have similar effects. There was less toxicity and greater tolerance in the docetaxel group.

並列關鍵字

non-small cell lung cancer (NSCLC) ； concurrent chemoradiotherapy (CCRT) ； survival ； cisplatin ； vinorelbine ； docetaxel