[VmP方案序贯治疗联合全脑放疗用于小细胞肺癌脑转移患者]

[Sequential treatment of VmP regimen and whole brain radiotherapy for small cell lung cancer patients with brain metastases].

作者信息

Yue Xiang, Zang Qin-Chuan

机构信息

Department of Medical Oncology, Nanjing Drum Tower Hospital, Medical College, Nanjing University, Nanjing, Jiangsu 210008, P.R. China.

出版信息

Ai Zheng. 2004 Dec;23(12):1671-6.

PMID:15601558

Abstract

BACKGROUND & OBJECTIVE: Median survival time (MST) of small cell lung cancer (SCLC) patients with brain metastases was short when patients were palliatively treated with either chemotherapy or whole brain radiotherapy (WBRT). This study was designed to compare therapeutic effects,toxicities,and survival time of 2 different sequential treatments of VmP regimen and WBRT for SCLC patients with brain metastases.

METHODS

According to bed availability, 38 naive SCLC patients with brain metastases were nonrandomized into group A and group B. There was no significant difference of characteristics between 2 groups (Chi-s Fisher's exact test, P >0.05). Patients in group A (VmP-WBRT) received 2 cycles of VmP regimen (teniposide, 60 mg/m(2),d(1-5), cisplatin, 25 mg/m(2), d(1-3), repeated every 4 weeks),and then WBRT (3 Gy x 10,within 2 weeks); patients in group B (WBRT-VmP) received the same WBRT in advance,and then 2 cycles of VmP regimen. Patients with single brain lesion received an extra 3 Gy x 5 radiotherapy on the limited field of brain lesion within 1 week after WBRT. All patients received 2-4 cycles of chemotherapy after sequential treatments.

RESULTS

Both sequential treatments relieved neurological symptoms of more than 80% of patients. Response rates of brain,lung,and total lesions of group A and B had no significant differences (68.2% vs. 75.0%, P=0.647; 77.3% vs. 75%, P=0.871; 63.6% vs. 56.3%, P=0.646,respectively). Time to progression (TTP) of group A was 6.0 (95% CI 4.4-7.6) months,of group B was 5.0 (95% CI 3.6-6.4) months (P=0.383). MST of group A was 12.0 (95% CI 7.9-16.1) months,of group B was 9.0 (95% CI 5.6-12.4) months (P=0.049). One-year survival rate of group A was 31.8%,of group B was 18.8% (P=0.281),and 2-year survival rates were 13.6%, and 6.3% (P=0.844). Myelosuppression was the main concentration-dependent toxicity. Incidence of vomit at stage III in group B was higher than that in group A (P=0.01). All treatment toxicities were tolerable and manageable.

CONCLUSION

Both sequential treatments can be safely performed for SCLC patients with brain metastases, may relieve neurological symptoms, and well control both primary and metastatic lesions. VmP-WBRT sequential treatment may prolong survival time of SCLC patients for 3 months.

摘要

背景与目的

小细胞肺癌（SCLC）脑转移患者接受化疗或全脑放疗（WBRT）姑息治疗时，中位生存时间（MST）较短。本研究旨在比较VmP方案与WBRT两种不同序贯治疗对SCLC脑转移患者的治疗效果、毒性及生存时间。

方法

根据床位情况，将38例初治的SCLC脑转移患者非随机分为A组和B组。两组患者特征无显著差异（卡方检验或Fisher精确检验，P>0.05）。A组（VmP-WBRT）患者先接受2周期VmP方案（替尼泊苷，60mg/m²，第1-5天；顺铂，25mg/m²，第1-3天，每4周重复），然后接受WBRT（3Gy×10次，2周内完成）；B组（WBRT-VmP）患者先接受相同的WBRT，然后接受2周期VmP方案。单发脑转移瘤患者在WBRT后1周内对脑转移瘤局限野追加3Gy×5次放疗。所有患者在序贯治疗后接受2-4周期化疗。

结果

两种序贯治疗均使80%以上患者的神经症状得到缓解。A组和B组脑、肺及总病灶的缓解率无显著差异（分别为68.2% vs. 75.0%，P=0.647；77.3% vs. 75%，P=0.871；63.6% vs. 56.3%，P=0.646）。A组的疾病进展时间（TTP）为6.0（95%CI 4.4-7.6）个月，B组为5.0（95%CI 3.6-6.4）个月（P=0.383）。A组的MST为12.0（95%CI 7.9-16.1）个月，B组为9.0（95%CI 5.6-12.4）个月（P=0.049）。A组1年生存率为31.8%，B组为18.8%（P=0.281），2年生存率分别为13.6%和6.3%（P=0.844）。骨髓抑制是主要的剂量依赖性毒性。B组Ⅲ度呕吐发生率高于A组（P=0.01）。所有治疗毒性均可耐受且可处理。