Myers Janet N, O'neil Kevin M, Walsh Thomas E, Hoffmeister Karen J, Venzon David J, Johnson Bruce E
Department of Medicine, Uniformed Services University of the Health Sciences, Pulmonary and Critical Care Division, Bethesda, MD 20814, USA.
Chest. 2005 Nov;128(5):3261-8. doi: 10.1378/chest.128.5.3261.
To describe pulmonary symptoms, signs, pulmonary function, and lung imaging studies in patients with limited-stage small cell lung cancer (SCLC) 2 to 15 years after receiving treatment with chemotherapy and chest radiotherapy.
Retrospective review of clinical records and radiographic studies of patients treated in three different prospective combined-modality studies.
Federal hospital.
One hundred fifty-six patients with SCLC who were enrolled between 1974 and 1994.
Patients with limited-stage SCLC treated on prospective therapeutic studies of combined chemotherapy and radiation therapy were identified. Pulmonary symptoms, physical findings, pulmonary function tests, arterial blood gas measurements, and chest imaging studies were assessed at baseline, and at 1 to 2 years, at 3 to 5 years, and at > 5 years following the initiation of treatment.
Initial symptoms included cough in 84 (55%), dyspnea in 59 (39%), and sputum production in 26 (17%). Twenty-three patients lived beyond 5 years (15%) without evidence of recurrence. Seven of these 5-year survivors were without pulmonary symptoms. Pulmonary function test results showed no significant changes in percent predicted values for FVC, FEV(1), and FEV(1)/FVC ratio over the time periods reviewed. The percent predicted values for the diffusing capacity of the lung for carbon monoxide decreased from 71% before the start of treatment to 56% (p < 0.032) at 1 to 2 years. Values improved in most patients beyond 5 years after starting treatment. Radiologist interpretations of chest imaging studies were available for 17 of 23 patients surviving > 5 years. Most patients had minimal to no changes in imaging study findings beyond 5 years.
Long-term survivors with limited-stage SCLC who were treated with combined chemotherapy and chest radiotherapy have minimal changes in pulmonary symptoms or function from 5 to 15 years after the start of treatment. A concern for late toxicity from combined-modality therapy should not dissuade clinicians from offering therapy with potentially curative result with minimal to no pulmonary dysfunction.
描述局限期小细胞肺癌（SCLC）患者在接受化疗和胸部放疗后2至15年的肺部症状、体征、肺功能及肺部影像学检查结果。
对三项不同前瞻性综合治疗研究中患者的临床记录和影像学研究进行回顾性分析。
联邦医院。
1974年至1994年间入组的156例SCLC患者。
确定在化疗联合放疗的前瞻性治疗研究中接受治疗的局限期SCLC患者。在基线时、治疗开始后1至2年、3至5年以及超过5年时评估肺部症状、体格检查结果、肺功能测试、动脉血气测量及胸部影像学检查。
初始症状包括咳嗽84例（55%）、呼吸困难59例（39%）、咳痰26例（17%）。23例患者存活超过5年（15%）且无复发迹象。这23例5年幸存者中有7例无肺部症状。肺功能测试结果显示，在回顾的时间段内，FVC、FEV₁和FEV₁/FVC比值的预计值百分比无显著变化。一氧化碳弥散量的预计值百分比从治疗开始前的71%降至1至2年时的56%（p<0.032）。大多数患者在开始治疗5年后数值有所改善。在存活超过5年的23例患者中，有17例可获得放射科医生对胸部影像学检查的解读。大多数患者在5年后影像学检查结果变化极小或无变化。
接受化疗联合胸部放疗的局限期SCLC长期幸存者在治疗开始后5至15年肺部症状或功能变化极小。对综合治疗晚期毒性的担忧不应阻止临床医生提供可能治愈且肺部功能障碍极小或无功能障碍的治疗。
