Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-chou, Suntou-gun, Shizuoka 411-8777, Japan.
Jpn J Clin Oncol. 2013 Feb;43(2):176-83. doi: 10.1093/jjco/hys197. Epub 2012 Dec 5.
As clinical trials for limited-disease small-cell lung cancer often exclude elderly patients due to comorbidities and a decline in organ function, the most suitable treatment for limited-disease small-cell lung cancer patients aged 75 years or older still remains unclear.
From July 2002 to June 2011, 20 consecutive patients aged 75 years or older, with Stage II to IIIB limited-disease small-cell lung cancer, were scheduled to be treated with concurrent or sequential chemoradiotherapy at the Shizuoka Cancer Center. We reviewed the medical charts of the patients and evaluated their characteristics, treatment compliance, toxicity and antitumor efficacy.
Five patients were treated with concurrent chemoradiotherapy and the other 15 patients were scheduled to be treated with sequential chemoradiotherapy. Of these 15 patients, 12 were treated with four cycles of etoposide (80 mg/m(2), days 1-3, q3-4w) plus carboplatin (area under the curve 5, day 1, q3-4w), followed by thoracic radiotherapy. Of the five patients treated with concurrent chemoradiotherapy, discontinuation of chemotherapy/thoracic radiotherapy occurred in two patients due to toxicity and they suffered a prolonged decrease in performance status. Of the 12 patients treated with etoposide plus carboplatin followed by sequential thoracic radiotherapy, the response rate, median progression-free survival and median overall survival time were 91%, 244 and 601 days.
These results suggest that concurrent chemoradiotherapy is not feasible for all limited-disease small-cell lung cancer patients aged 75 years or older. The alternative of four cycles of etoposide plus carboplatin followed by thoracic radiotherapy is a candidate for the standard treatment of limited-disease small-cell lung cancer patients in this age group. A further trial is warranted to develop and evaluate the optimal treatment for elderly patients with limited-disease small-cell lung cancer.
由于合并症和器官功能下降，临床试验常将老年患者排除在局限期小细胞肺癌之外，因此 75 岁及以上局限期小细胞肺癌患者的最佳治疗方法仍不明确。
2002 年 7 月至 2011 年 6 月，20 例年龄 75 岁及以上、Ⅱ期至Ⅲ B 期局限期小细胞肺癌患者在静冈癌症中心接受同步或序贯放化疗。我们回顾了患者的病历，并评估了他们的特征、治疗依从性、毒性和抗肿瘤疗效。
5 例患者接受同步放化疗，15 例患者接受序贯放化疗。15 例患者中，12 例接受依托泊苷（80mg/m²，第 1-3 天，q3-4w）加卡铂（曲线下面积 5，第 1 天，q3-4w）4 个周期，然后进行胸部放疗。5 例接受同步放化疗的患者中，由于毒性，2 例患者停止化疗/胸部放疗，导致体能状态下降时间延长。12 例接受依托泊苷加卡铂序贯胸部放疗的患者中，缓解率、中位无进展生存期和中位总生存期分别为 91%、244 天和 601 天。
这些结果表明，同步放化疗并非所有 75 岁及以上局限期小细胞肺癌患者都适用。依托泊苷加卡铂 4 个周期序贯胸部放疗是该年龄组局限期小细胞肺癌患者标准治疗的候选方案。需要进一步的试验来制定和评估老年局限期小细胞肺癌患者的最佳治疗方法。
