在接受吉西他滨和卡铂诱导治疗后，同步放疗和吉西他滨治疗的局部晚期非小细胞肺癌患者中放射性肺炎的高发生率。

High frequency of radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent radiotherapy and gemcitabine after induction with gemcitabine and carboplatin.

作者信息

Arrieta Oscar, Gallardo-Rincón Dolores, Villarreal-Garza Cynthia, Michel Rosa M, Astorga-Ramos Alma M, Martínez-Barrera Luis, de la Garza Jaime

机构信息

Department of Medical Oncology, Experimental Oncology Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico.

出版信息

J Thorac Oncol. 2009 Jul;4(7):845-52. doi: 10.1097/JTO.0b013e3181a97e17.

DOI:10.1097/JTO.0b013e3181a97e17

PMID:19487963

Abstract

INTRODUCTION

The combination of chemotherapy and thoracic radiation is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, most favorable chemotherapy regimen, timing of full-dose chemotherapy, and optimal combination of chemotherapy with radiation remain to be determined. Our primary objective was to evaluate the efficacy and safety of gemcitabine concurrent with radiotherapy after induction chemotherapy with gemcitabine plus carboplatin for locally advanced NSCLC.

PATIENTS AND METHODS

Patients with histologically proven NSCLC stage IIIA and -B received carboplatin (area under the curve of 2.5) and gemcitabine (800 mg/m) on days 1 and 8, every 21 days for two cycles, followed by conventional fractioned thoracic radiotherapy and concomitant weekly gemcitabine 200 mg/m, and finally, consolidation chemotherapy.

RESULTS

Inclusion was discontinued because of high-grade 3 to 5 radiation-pneumonitis events (6 of 19 patients, 31.6%), including one treatment-related death associated with radiation pneumonitis. Median follow-up was 11.9 months. Most common grades 3/4 hematological side effects comprised anemia, neutropenia 3 of 19 patients, each (15.8%), and thrombocytopenia (4 of 19, 21.1%) during induction. Partial response was observed in 10 patients (52.6%) following induction chemotherapy. After concurrent chemo-radiotherapy, overall response was 68.4%. Four patients (21.1%) underwent surgical resection. Median progression-free survival and overall survival were 12 +/- 1 month (95% confidence interval [CI], 9.8-14.1) and 21 +/- 3.5 months (95% CI, 14-27.9 months), respectively.

CONCLUSION

Concurrent radiotherapy with gemcitabine after induction with gemcitabine and carboplatin showed a high-response rate; however, it is associated with excessive pulmonary toxicity. Adjustments in gemcitabine dosage during radiotherapy or changes in radiotherapy planning could reduce toxicity.

摘要

引言

化疗与胸部放疗联合是局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。然而，最适宜的化疗方案、全剂量化疗的时机以及化疗与放疗的最佳联合方式仍有待确定。我们的主要目的是评估吉西他滨联合卡铂诱导化疗后，吉西他滨与放疗同步进行对局部晚期NSCLC的疗效和安全性。

患者与方法

组织学确诊为ⅢA期和ⅢB期NSCLC的患者，每21天为一周期，在第1天和第8天接受卡铂（曲线下面积为2.5）和吉西他滨（800mg/m²）治疗，共两个周期，随后进行常规分割胸部放疗并每周同步给予吉西他滨200mg/m²，最后进行巩固化疗。

结果

由于3至5级放射性肺炎事件发生率高（19例患者中有6例，31.6%），包括1例与放射性肺炎相关的治疗相关死亡，纳入研究被终止。中位随访时间为11.9个月。诱导治疗期间最常见的3/4级血液学副作用包括贫血、中性粒细胞减少（19例患者中各有3例，15.8%）和血小板减少（共4例，21.1%）。诱导化疗后10例患者（52.6%）观察到部分缓解。同步放化疗后，总缓解率为68.4%。4例患者（21.1%）接受了手术切除。中位无进展生存期和总生存期分别为12±1个月（95%置信区间[CI]，9.8 - 14.1）和21±3.5个月（95%CI，14 - 27.9个月）。