Belch A R, Urtasun R C, Bodnar D, Kinney B, Amy R
Department of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta Canada.
NCI Monogr. 1988(6):271-4.
Previously, investigators at this institute have studied the use of upper hemibody irradiation as a consolidation agent following combination chemotherapy for small cell lung cancer. There was no improvement in survival compared to that in the group treated with chemotherapy alone. In our present pilot study, we are investigating the toxicity and efficacy of using hemibody irradiation (HBI) as a non-cross-resistant agent early in a program of alternating chemotherapy consisting of six treatment cycles. Toxicity due to the combined effects of chemotherapy (cisplatin and etoposide plus cyclophosphamide, doxorubicin, and vincristine) plus HBI is reported. The HBI was given at a dose of 1,000 cGy in four fractions for limited disease or as a single 800-cGy dose for extensive disease. Bone marrow suppression following HBI necessitated a subsequent delay in the chemotherapy cycle or dose reduction in 55% of the 33 patients. Six patients developed diffuse interstitial pneumonitis following chemotherapy and HBI; 3 have died, and in 2 of these, the etiology was opportunistic infection. In our previous studies utilizing HBI either alone or as consolidation therapy after induction chemotherapy, a low incidence of lung toxicity occurred. This increased incidence suggests a possible drug-radiation interaction when HBI is used as an alternating agent with doxorubicin and cisplatin.
此前，该研究所的研究人员研究了半身照射作为小细胞肺癌联合化疗后巩固治疗手段的应用情况。与单纯接受化疗的组相比，生存率并无改善。在我们目前的初步研究中，我们正在研究在由六个治疗周期组成的交替化疗方案早期，将半身照射（HBI）用作非交叉耐药药物的毒性和疗效。报告了化疗（顺铂、依托泊苷加环磷酰胺、阿霉素和长春新碱）加HBI联合作用导致的毒性。对于局限性疾病，HBI以1000厘戈瑞分四次给予；对于广泛性疾病，则作为单次800厘戈瑞剂量给予。33例患者中有55%在接受HBI后出现骨髓抑制，这使得后续化疗周期不得不推迟或剂量减少。6例患者在化疗和HBI后发生弥漫性间质性肺炎；3例死亡，其中2例的病因是机会性感染。在我们之前单独使用HBI或在诱导化疗后将其用作巩固治疗的研究中，肺部毒性的发生率较低。这种发生率的增加表明，当HBI与阿霉素和顺铂交替使用时，可能存在药物与辐射的相互作用。
