Yamada K, Saijo N, Kojima A, Ohe Y, Tamura T, Sasaki Y, Eguchi K, Shinkai T, Goya T, Kondou H
Department of Internal Medicine, National Cancer Center Hospital, Tokyo.
Jpn J Clin Oncol. 1991 Feb;21(1):39-45.
From 1984 to 1989, 20 of 142 patients with small cell carcinoma of the lung received surgery after intensive chemotherapy alone or chemotherapy combined with thoracic irradiation. All patients giving informed consent and having an Eastern Cooperative Oncology Group (ECOG) performance status 0-1 were included in the present retrospective study. Ages ranged from 37-74 (median 58) years. All patients received 1-10 cycles of chemotherapy intravenously every three or four weeks (PVP: 80 mg cisplatin/m2, 100 mg etoposide/m2 x 3; CAV: 800 mg cyclophosphamide/m2, 50 mg doxorubicin/m2, 1.4 mg vincristine/m2, and other combinations) and were evaluated for surgery 1-27 months after the initial systemic chemotherapy. Clinically, two, three, eleven and for patients were diagnosed as having stages I, II, III and IV disease, respectively at the beginning of treatment. At the time of reevaluation after chemotherapy or chemotherapy plus chest radiotherapy there were one (5%) complete responder, 17 (85%) partial responders, and two (10%) with stable disease. Twenty patients underwent thoracotomy consisting of nine lobectomies and 11 pneumonectomies. Eighteen of the 20 had resectable lesions. According to postoperative pathological findings, there were six, one, seven and two patients with stages I, II, III and IV disease, respectively. In two patients no tumor was demonstrated pathologically. Small cell carcinoma was detected in 15 specimens and three had non-small cell carcinoma. Two of the 20 patients survived for more than five years. The median survival of the 20 patients was 22 months. It would appear that resection is applicable in only a selected subset of patients with small cell carcinoma of the lung.
1984年至1989年期间，142例肺小细胞癌患者中有20例在单纯强化化疗或化疗联合胸部放疗后接受了手术。所有签署知情同意书且东部肿瘤协作组（ECOG）体能状态为0 - 1级的患者均纳入本回顾性研究。年龄范围为37 - 74岁（中位年龄58岁）。所有患者每三或四周静脉接受1 - 10周期化疗（PVP方案：顺铂80 mg/m²，依托泊苷[足叶乙苷]100 mg/m²×3；CAV方案：环磷酰胺800 mg/m²，多柔比星[阿霉素]50 mg/m²，长春新碱1.4 mg/m²，以及其他联合方案），并在初始全身化疗后1 - 27个月接受手术评估。临床上，治疗开始时分别有2例、3例、11例和4例患者被诊断为Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期疾病。化疗或化疗加胸部放疗后重新评估时，有1例（5%）完全缓解者，17例（85%）部分缓解者，2例（10%）病情稳定。20例患者接受了开胸手术，包括9例肺叶切除术和11例全肺切除术。20例中有18例有可切除病灶。根据术后病理结果，分别有6例、1例、7例和2例患者为Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期疾病。2例患者病理检查未发现肿瘤。15份标本检测出小细胞癌，3份为非小细胞癌。20例患者中有2例存活超过5年。20例患者的中位生存期为22个月。看来手术切除仅适用于一小部分肺小细胞癌患者。
