Yang C L, Ma L X, Sun S Y, Cui H X, Li Z L, Cheng Y
Department of Thoracic Oncology, Jilin Province Cancer Hospital, Changchun 130012, China.
Department of Radiology, Jilin Province Cancer Hospital, Changchun 130012, China.
Zhonghua Zhong Liu Za Zhi. 2016 Jun 23;38(6):454-9. doi: 10.3760/cma.j.issn.0253-3766.2016.06.010.
To explore the efficiency and adverse effects of the effective EP (etoposide + cisplatin) therapy and its subsequent maintenance therapy with different durations in patients with small cell lung cancer (SCLC).
Clinical data of 104 SCLC patients diagnosed and treated at the Jilin Province Cancer Hospital between September 2010 and December 2013 were retrospectively analyzed.Among them, 35 patients were subsequently treated with a 4-week maintenance therapy following the original therapeutic regimen after the effective EP therapy (4-week maintenance therapy group), 35 patients were treated with a subsequent 6-week maintenance therapy (6-week maintenance therapy group), and 34 patients were treated without maintenance therapy (control group).52 patients were in limited stage, and 52 patients were in extensive stage. The progression-free survival (PFS), overall survival (OS) and adverse effects in the 4-week maintenance therapy group, 6-week maintenance therapy group and control group were analyzed.
The median PFS in the control group, 4-week maintenance therapy group and 6-week maintenance therapy group was 4.0, 3.5, and 4.0 months, respectively, and the median OS was 9.0, 10.0 and 12.0 months, respectively, showing no significant difference among the groups (P>0.05 for all). The median PFS was prolonged by 2 months as compared with the control group after the 4-week maintenance therapy in the patients with complete remission in first-line chemotherapy (P=0.041), while the median OS was not improved (P=0.131). Neither the median PFS nor median OS showed statistically significant difference between each two groups in the patients with partial remission in first-line chemotherapy (P>0.05 for all). In the limited stage, the median PFS in the control group, 4-week maintenance therapy group, and 6-week maintenance therapy group was 5.0, 6.5, and 4.0 months, respectively, and median OS was 11.0, 13.5, and 13.0 months, respectively, the differences showed no statistical significance (P>0.05 for all). In the extensive stage, the median PFS in the control group, 4-week maintenance therapy group, and 6-week maintenance therapy group was 3.0, 3.0, and 3.5 months, respectively, showing significant differences (P=0.015); the median OS was 6.5, 8.0, and 8.0 months, respectively, presenting no statistically significant differences (P=0.096). In addition, the PFS in the 6-week maintenance therapy group was significantly improved as compared with that in the control group (P=0.016). Compared with the control group, the incidence rates of nausea (grade 3-4), vomiting, hypodynamia, leukopenia, neutropenia, and thrombocytopenia in the 4-week maintenance therapy group and 6-week maintenance therapy group were increased significantly (P<0.05 for all), however, the side effects were tolerable.
Prolonging the treatment cycle of EP therapy can improve the PFS in SCLC patients in first-line CR chemotherapy and extensive stage.
探讨小细胞肺癌（SCLC）患者中有效的EP（依托泊苷+顺铂）治疗及其后续不同疗程维持治疗的疗效和不良反应。
回顾性分析2010年9月至2013年12月在吉林省肿瘤医院确诊并接受治疗的104例SCLC患者的临床资料。其中，35例患者在有效的EP治疗后按照原治疗方案接受4周维持治疗（4周维持治疗组），35例患者接受后续6周维持治疗（6周维持治疗组），34例患者未接受维持治疗（对照组）。52例患者为局限期，52例患者为广泛期。分析4周维持治疗组、6周维持治疗组和对照组的无进展生存期（PFS）、总生存期（OS）及不良反应。
对照组、4周维持治疗组和6周维持治疗组的中位PFS分别为4.0、3.5和4.0个月，中位OS分别为9.0、10.0和12.0个月，组间差异均无统计学意义（均P>0.05）。一线化疗完全缓解的患者在4周维持治疗后，中位PFS较对照组延长2个月（P=0.041），而中位OS未改善（P=0.131）。一线化疗部分缓解的患者，两两比较中位PFS和中位OS差异均无统计学意义（均P>0.05）。在局限期，对照组、4周维持治疗组和6周维持治疗组的中位PFS分别为5.0、6.5和4.0个月，中位OS分别为11.0、13.5和13.0个月，差异均无统计学意义（均P>0.05）。在广泛期，对照组、4周维持治疗组和6周维持治疗组的中位PFS分别为3.0、3.0和3.5个月，差异有统计学意义（P=0.015）；中位OS分别为6.5、8.0和8.0个月，差异无统计学意义（P=0.096）。此外，6周维持治疗组的PFS较对照组显著改善（P=0.016）。与对照组相比，4周维持治疗组和6周维持治疗组恶心（3-4级）、呕吐、乏力、白细胞减少、中性粒细胞减少和血小板减少的发生率显著增加（均P<0.05），但副作用可耐受。
延长EP治疗周期可改善一线CR化疗及广泛期SCLC患者的PFS。
