Drings P, Wannenmacher M
Thoraxklinik-Heidelberg gGmbH, Heidelberg.
Dtsch Med Wochenschr. 2005 Jun 17;130(24):1507-11. doi: 10.1055/s-2005-870848.
As a consequence of tumour and therapy related effects anaemia is a particularly frequent occurrence in patients with lung cancer. The ensuing symptoms such as dyspnoea, fatigue and decreased general health reduce their quality of life and can impede if not altogether prevent an effective cytostatic therapy. A positive outcome after oxygen-dependent anti-tumour therapy, for example radiation therapy or various cytostatic treatments as well, can be reduced or even put at risk when tumour tissue is hypoxic. In order to treat anaemia, recombinant human erythropoietin can be used beside blood transfusions. Erythropoietins are well tolerated and allow for a long-lasting, gradual increase of Hb-levels, which cannot be achieved via transfusions. Furthermore, transfusion risks such as intolerance reactions or disease transmission can also be avoided. The various studies presented here evaluated the impact of anaemia treatment with erythropoietins on the need for transfusions and quality of life of patients with lung cancer over the last few years. They all agreed in their conclusion that both parameters can be improved with erythropoietin therapy. It turned out that the patients' quality of life improved most when Hb levels reached around 12 g/dl . Studies examining the impact of anaemia treatment on a patient's prognosis also showed positive effects in the majority of cases. In order to investigate this issue, our Heidelberg work group has designed a prospective, randomised phase-III study on NSCLC patients, which will be explained in detail further down.
由于肿瘤及治疗相关影响,贫血在肺癌患者中尤为常见。随之而来的症状,如呼吸困难、疲劳和整体健康状况下降,会降低他们的生活质量,并且即使不完全阻碍也会妨碍有效的细胞毒性疗法。当肿瘤组织缺氧时,依赖氧气的抗肿瘤治疗(例如放射治疗或各种细胞毒性治疗)后的积极结果可能会降低,甚至面临风险。为了治疗贫血,除输血外,还可使用重组人促红细胞生成素。促红细胞生成素耐受性良好,可使血红蛋白水平持久、逐渐升高,这是输血无法实现的。此外,还可避免输血风险,如不耐受反应或疾病传播。此处介绍的各项研究评估了过去几年中使用促红细胞生成素治疗贫血对肺癌患者输血需求和生活质量的影响。他们都一致得出结论,促红细胞生成素治疗可改善这两个参数。结果发现,当血红蛋白水平达到约12 g/dl时,患者的生活质量改善最为明显。研究贫血治疗对患者预后影响的研究在大多数情况下也显示出积极效果。为了研究这个问题,我们海德堡的工作组针对非小细胞肺癌患者设计了一项前瞻性、随机III期研究,将在下文详细解释。