Lupattelli M, Maranzano E, Bellavita R, Chionne F, Darwish S, Piro F, Latini P
Radiation Oncology Center, Perugia, Italy.
Am J Clin Oncol. 2000 Feb;23(1):89-93. doi: 10.1097/00000421-200002000-00024.
From February 1993 to October 1997, 91 consecutive patients with inoperable (stage IIIB-IV) histologically confirmed non-small-cell lung cancer underwent palliative hypofractionated radiotherapy. Recently, the Medical Research Council studies on hypofractionated short-course radiotherapy (8.5 Gy x 2) have reported high control of symptoms caused by thoracic disease without toxicity. Based on these experiences and our previous positive trial on short-course radiotherapy (8 Gy x 2) in metastatic spinal cord compression, a prospective study of short-course palliative radiotherapy in non-small-cell lung cancer was carried out. The regimen was 16 Gy given in two 8-Gy fractions, 1 week apart. Eighty-one patients were evaluable for response to treatment. Forty-eight (59%) patients were 65 years or older. Forty (49%) patients were naive to radiotherapy, whereas 41 (51%) had previous cisplatin-based chemotherapy. All but four stage IV patients (95%) had poor Eastern Cooperative Oncology Group performance status (i.e., 2-3). Clinical palliation was achieved in 62 (77%) patients. Performance status improved in 59 (73%) patients. The median palliation time ranged from 28% to 57% of patient survival. The median survival from the beginning of treatment was 148 days (range, 5-681 days). No difference in overall survival according to stage and previous chemotherapy was observed. Only performance status conditioned survival (performance status 1-2 vs. performance status 3; p = 0.0289). Short-course radiotherapy gave good results in terms of clinical palliation for thoracic symptoms, even in patients with poor performance status and pretreated with chemotherapy. The median palliation time was approximately 50% of patient survival time. Treatment was generally well tolerated-only 4 (5%) patients experienced World Health Organization grade III dysphagia. No late toxicity was recorded. The two-fraction regimen had social and economic advantages compared with the conventional ones.
1993年2月至1997年10月，91例经组织学确诊为不可切除（ⅢB - Ⅳ期）的非小细胞肺癌患者接受了姑息性大分割放疗。最近，医学研究委员会关于大分割短程放疗（8.5 Gy×2）的研究报告显示，对胸部疾病引起的症状有高度控制且无毒性。基于这些经验以及我们之前在转移性脊髓压迫症短程放疗（8 Gy×2）方面的阳性试验，开展了一项非小细胞肺癌短程姑息放疗的前瞻性研究。方案为分两次给予16 Gy，每次8 Gy，间隔1周。81例患者可评估治疗反应。48例（59%）患者年龄在65岁及以上。40例（49%）患者未曾接受过放疗，而41例（51%）曾接受过以顺铂为基础的化疗。除4例Ⅳ期患者外，所有患者（95%）东部肿瘤协作组体能状态较差（即2 - 3级）。62例（77%）患者实现了临床缓解。59例（73%）患者体能状态得到改善。中位缓解时间为患者生存时间的28%至57%。从治疗开始的中位生存期为148天（范围5 - 681天）。未观察到根据分期和既往化疗情况在总生存期上的差异。只有体能状态影响生存期（体能状态1 - 2级与3级；p = 0.0289）。短程放疗在缓解胸部症状方面取得了良好效果，即使是体能状态较差且接受过化疗的患者。中位缓解时间约为患者生存时间的50%。治疗一般耐受性良好，只有4例（5%）患者出现世界卫生组织Ⅲ级吞咽困难。未记录到晚期毒性。与传统方案相比，两分割方案具有社会和经济优势。
