Imamura Fumio, Konishi Koji, Uchida Junji, Nishino Kazumi, Okuyama Takako, Kumagai Toru, Kawaguchi Yoshifumi, Nishiyama Kinji
Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Clin Lung Cancer. 2014 Jul;15(4):281-6. doi: 10.1016/j.cllc.2014.02.001. Epub 2014 Feb 19.
Lung cancer is a leading cause of cancer death in the world. The results from concurrent chemoradiotherapy (CRT) are still disappointing, although long-term survival can be observed in certain populations of patients. Local control is a critical problem in CRT; dose escalation of thoracic radiation (TRT) in CRT has not been effective.
The authors developed a novel TRT scheme of accelerated hyperfractionation using concomitant boost TRT (ccbRT). Total doses of 64 Gy and 40 Gy were given to the gross tumor volume and elective clinical target volume, respectively, for 20 working days, combined with systemic chemotherapy with cisplatin (day 1) and vinorelbine (days 1, 8) with a 3-week interval (NP regimen). The purpose of this phase II study was to evaluate the efficacy and toxicity of this novel treatment.
From July 2002 to July 2010, 56 patients were enrolled in this study. One patient was excluded from the analysis. All 55 patients completed ccbRT, and 52 patients (94.5%) underwent at least 2 cycles of NP. Grade 3 esophagitis and grade 3 radiation pneumonitis were observed in 18.2% and 3.6% of the patients. Complete response and partial response were achieved in 24.5% and 69.1% of the patients, resulting in a response rate of 93.6%. The median progression-free survival (PFS) and overall survival (OS) times were 16.7 months and 58.2 months.
CRT using ccbRT with concurrent NP is safe and effective for locally advanced non-small-cell lung cancer, with good PFS and excellent OS.
肺癌是全球癌症死亡的主要原因。尽管在某些患者群体中可观察到长期生存，但同步放化疗（CRT）的结果仍不尽人意。局部控制是CRT中的关键问题；CRT中胸部放疗（TRT）的剂量递增并不有效。
作者研发了一种采用同步推量TRT（ccbRT）的加速超分割新型TRT方案。分别给予大体肿瘤体积和选择性临床靶体积64 Gy和40 Gy的总剂量，持续20个工作日，联合顺铂（第1天）和长春瑞滨（第1天、第8天）的全身化疗，间隔3周（NP方案）。这项II期研究的目的是评估这种新型治疗的疗效和毒性。
2002年7月至2010年7月，56例患者纳入本研究。1例患者被排除在分析之外。所有55例患者均完成ccbRT，52例患者（94.5%）接受了至少2个周期的NP治疗。18.2%和3.6%的患者出现3级食管炎和3级放射性肺炎。24.5%和69.1%的患者达到完全缓解和部分缓解，缓解率为93.6%。中位无进展生存期（PFS）和总生存期（OS）分别为16.7个月和58.2个月。
采用ccbRT联合同步NP的CRT对局部晚期非小细胞肺癌安全有效，具有良好的PFS和出色的OS。
