The commonest grade 3-4 toxic effects were neutropenia ( 68 [ 19 % ] patients in the chemotherapy group , 58 [ 17 % ] patients in the sequential chemoimmunotherapy group , and 79 [ 22 % ] patients in the concurrent chemoimmunotherapy group ; fatigue ( 27 [ 8 % ] in the chemotherapy group , 35 [ 10 % ] in the sequential chemoimmunotherapy group , and 44 [ 12 % ] in the concurrent chemoimmunotherapy group ) ; and pain ( 34 [ 9 % ] patients in the chemotherapy group , 39 [ 11 % ] in the sequential chemoimmunotherapy group , and 41 [ 12 % ] in the concurrent chemoimmunotherapy group ) .