Mira J G, Taylor S L, Stephens R L, Chen T
University of Texas, Cancer Therapy and Research Foundation, San Antonio, TX 78229.
Int J Radiat Oncol Biol Phys. 1988 Sep;15(3):757-61. doi: 10.1016/0360-3016(88)90323-9.
From September 1980 to March 1983, 30 cases were registered in a Southwest Oncology Group Study. Twenty-four cases were evaluable and constitute the basis for this report. Patients were diagnosed with adenocarcinoma or large cell lung carcinoma. Tumors were considered inoperable but able to be encompassed in a single radiotherapy (RT) port. Seventy-two percent of measured tumors were 4 cm in diameter or bigger (range 2 cm to 10 cm). RT was given initially to the primary lung tumor and ipsilateral hilar, mediastinal, and supraclavicular nodes, at 2 Gy per day; total dose was 44 Gy. The areas involved by tumor were boosted with 10 Gy more. Prophylactic cranial irradiation (PCI) was started at the same time with 15 treatments of 2.75 Gy. A 2-week rest period was instituted after the first 11 treatments. Chemotherapy (CT) was given from day 1 which consisted of 5-Flourouracil, 500 mg./M2, (bolus day 1 and 8) Vincristine, 1 mg./M2, and Mitomycin C, 5 mg./M2 both given on day 1. Cycles were repeated at 28 day intervals for 3 cycles and at 6 week intervals for 5 more cycles, or until progression, with persistent disease. Eight cases (33%) achieved complete response (CR), and 5 (21%) partial response (PR). Overall median survival was 37 weeks and 2 years survival was 8%. CR patients had the best chance for long-term survival. Relapses were evenly distributed between extra and intrathoracic sites, with the latter even between the inside and outside the RT field. No patient died with clinical evidence of metastasis to the brain (MB), although one was found to have MB at autopsy. Toxicity was severe in 7 cases (29%) and 2 deaths are considered toxicity related. When comparing these results to those from the literature, we found this protocol has achieved a slightly higher CR rate than what is expected with RT alone, without survival improvement. As CR patients have the best prognosis, simultaneous CT-RT might offer some promise, but at the expense of increased toxicity. PCI was effective in preventing or delaying MB, and thus deserves further investigation. We should caution that the study of possible long-term effects of PCI could not be assessed because of the short median survival of the patients. It is possible that a less aggressive time-dose fractionation to the brain might be as effective as the one used in this protocol.
1980年9月至1983年3月，西南肿瘤协作组研究登记了30例病例。其中24例可评估，构成了本报告的基础。患者被诊断为腺癌或大细胞肺癌。肿瘤被认为无法手术切除，但可纳入单一放疗（RT）野。72%测量的肿瘤直径为4厘米或更大（范围2厘米至10厘米）。最初对原发性肺肿瘤及同侧肺门、纵隔和锁骨上淋巴结进行放疗，每天2 Gy；总剂量为44 Gy。肿瘤累及区域再追加10 Gy。同时开始预防性颅脑照射（PCI），共15次，每次2.75 Gy。前11次治疗后安排2周休息期。从第1天开始给予化疗（CT），方案为氟尿嘧啶500 mg/M²（第1天和第8天推注）、长春新碱1 mg/M²和丝裂霉素C 5 mg/M²，均在第1天给药。周期每28天重复一次，共3个周期，之后每6周重复一次，再进行5个周期，或直至病情进展出现持续性疾病。8例（33%）达到完全缓解（CR），5例（21%）部分缓解（PR）。总体中位生存期为37周，2年生存率为8%。CR患者长期生存机会最佳。复发在胸外和胸内部位分布均匀，胸内复发在放疗野内外分布也均匀。没有患者因脑转移（MB）的临床证据死亡，尽管尸检发现1例有MB。7例（29%）毒性严重，2例死亡被认为与毒性相关。将这些结果与文献中的结果比较时，我们发现本方案的CR率略高于单纯放疗预期的CR率，但未改善生存率。由于CR患者预后最佳，同步CT-RT可能有一定前景，但代价是毒性增加。PCI在预防或延迟MB方面有效，因此值得进一步研究。我们应提醒，由于患者中位生存期短，无法评估PCI可能的长期影响。对脑采用不太激进的时间-剂量分割可能与本方案使用的方法一样有效。
