Choi N C, Carey R W
Massachusetts General Hospital, Harvard Medical School, Boston.
Int J Radiat Oncol Biol Phys. 1989 Aug;17(2):307-10. doi: 10.1016/0360-3016(89)90444-6.
Between 1974 and 1986, 576 patients (284 limited and 292 extensive stages) were treated at this institution. To keep multiagent chemotherapy (CT) at a uniform intensity, patients who received (a) combined modality approach of both multiagent chemotherapy and thoracic radiotherapy (RT) and (b) greater than or equal to 3 cycles of multiagent chemotherapy (greater than or equal to 3 drugs), were chosen for this analysis. Out of 284 patients with limited Stage small-cell lung carcinoma, there were 154 such patients who met these strict criteria, and the treatment methods for the remaining 130 patients were as follows: (a) chemotherapy alone with radiotherapy reserved for local failure (47 pts); (b) radiotherapy alone (20 pts); (c) surgery +/- adjuvant chemotherapy or radiotherapy (37 pts); (d) modified chemotherapy plus radiotherapy (26 pts). During the 12-year period, the therapeutic factors have evolved. Radiation-dose was increased from 30-40 Gy (time dose fractionation 49-66) in 1974-1977 to 44-52 Gy (time dose fractionation 73-86) in 1978-1986. The target volume for radiotherapy included the primary lesion with a 2-cm margin of normal lung and the mediastinum. Chemotherapy program also evolved from COP, CAV (1974-1977) to MACC, VCE-VCA, PCE-ACE (1978-1986). Fifty of 154 patients (32%) developed loco-regional recurrence (infield failure) and 98% (49/50) of these patients exhibited this by 2.5 years. Survival data of 154 patients were as follows: (a) Median survival time (MST) was 12 M; (b) actuarial survival rates at 2 and 5 years were 21% and 8%, respectively. Fifty percent of these patients died within 12 months (MST 12 M) and were not exposed to the full length of the risk period for loco-regional failure. To take into account the duration of exposure to the risk period, actuarial method was employed to measure the probability of loco-regional failure. Loco-regional failure rates at 2.5 years were 37%, 39%, 49%, 79%, and 84% for 50 Gy, 45 Gy, 40 Gy, 35 Gy, and 30 Gy, respectively. The difference between the recurrence rates of 37% and 79% by 50 Gy and 35 Gy was statistically significant, p less than 0.05. Although the recurrence rates of 37% and 49% by 50 Gy and 40 Gy were not statistically different, there was a strong trend of a better control rate of loco-regional carcinoma by higher radiation doses. The time to recurrence seems also shorter with lower radiation-dose than that of higher radiation doses.(ABSTRACT TRUNCATED AT 400 WORDS)
1974年至1986年间，该机构共治疗了576例患者（284例局限期和292例广泛期）。为使多药化疗（CT）强度保持一致，本分析选取了接受以下治疗的患者：（a）多药化疗与胸部放疗（RT）联合治疗方案；（b）≥3周期多药化疗（≥3种药物）。在284例局限期小细胞肺癌患者中，有154例符合这些严格标准，其余130例患者的治疗方法如下：（a）单纯化疗，放疗用于局部失败情况（47例）；（b）单纯放疗（20例）；（c）手术±辅助化疗或放疗（37例）；（d）改良化疗加放疗（26例）。在这12年期间，治疗因素有所演变。放射剂量从1974 - 1977年的30 - 40 Gy（时间剂量分割49 - 66）增加到1978 - 1986年的44 - 52 Gy（时间剂量分割73 - 86）。放疗靶区包括原发灶及周边2 cm正常肺组织和纵隔。化疗方案也从COP、CAV（1974 - 1977年）演变为MACC、VCE - VCA、PCE - ACE（1978 - 1986年）。154例患者中有50例（32%）发生局部区域复发（野内失败），其中98%（49/50）的患者在2.5年内出现复发。154例患者的生存数据如下：（a）中位生存时间（MST）为12个月；（b）2年和5年的精算生存率分别为21%和8%。这些患者中有50%在12个月内死亡（MST 12个月），未经历局部区域失败的完整风险期。为考虑暴露于风险期的时长，采用精算方法测量局部区域失败的概率。50 Gy、45 Gy、40 Gy、35 Gy和30 Gy剂量下，2.5年时的局部区域失败率分别为37%、39%、49%、79%和84%。50 Gy和35 Gy剂量下复发率37%和79%的差异具有统计学意义，p＜0.05。尽管50 Gy和40 Gy剂量下37%和49%的复发率无统计学差异，但高放射剂量对局部区域癌的控制率有明显更好的趋势。低放射剂量下复发时间似乎也比高放射剂量时短。（摘要截短至400字）
