Warner-Efrati E, Sulkes A, Weshler Z, Peretz T, Ben-Yosef R, Catane R, Biran S
Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel.
Isr J Med Sci. 1988 Sep-Oct;24(9-10):593-8.
Forty-four evaluable, previously untreated patients with small cell lung cancer were treated with two courses of induction chemotherapy consisting of POCC. Subsequently, all limited-disease patients and extensive-disease patients in CR received 4,000 to 5,000 cGy irradiation over 4 to 5 weeks (or the equivalent) to the primary tumor, mediastinum and supraclavicular areas and 3,000 cGy prophylactic cranial irradiation during 2 weeks. All patients received maintenance chemotherapy for a full year after CR or until disease progression. Eleven continued POCC while 33 received vinblastine, cyclophosphamide, and either adriamycin or methotrexate on an alternating schedule (VCMA). For the 20 limited-disease patients, the CR rate was 70% and the PR rate was 20%. Median survival was 22 months, local control was 62%, 2-year DFS was 35% and 3-year DFS was 20%. Of the 24 extensive-disease patients only 21% achieved CR and 54% achieved PR. Median survival was only 8 months and there were no disease-free survivors at 2 years. Toxicity was moderate with nausea and vomiting in all patients, and there were two deaths from myelosuppression in the group that received POCC maintenance therapy; there were no drug-related deaths in the VCMA group. Since these results are similar to those obtained with simpler regimes, we cannot recommend our regimen for the treatment of small cell lung cancer. The optimal treatment for this disease has yet to be elucidated.
44例可评估的、既往未接受过治疗的小细胞肺癌患者接受了两个疗程的由POCC组成的诱导化疗。随后，所有局限期患者和完全缓解（CR）的广泛期患者在4至5周内（或等效时间）接受4000至5000 cGy的照射，照射部位为原发肿瘤、纵隔和锁骨上区域，并在2周内接受3000 cGy的预防性颅脑照射。所有患者在CR后接受为期一整年的维持化疗，直至疾病进展。11例患者继续接受POCC治疗，33例患者接受长春碱、环磷酰胺以及阿霉素或甲氨蝶呤交替方案（VCMA）治疗。对于20例局限期患者，CR率为70%，部分缓解（PR）率为20%。中位生存期为22个月，局部控制率为62%，2年无病生存率（DFS）为35%，3年DFS为20%。在24例广泛期患者中，仅21%达到CR，54%达到PR。中位生存期仅8个月，2年时无无病生存者。毒性反应为中度，所有患者均出现恶心和呕吐，接受POCC维持治疗的患者中有2例死于骨髓抑制；VCMA组无药物相关死亡病例。由于这些结果与采用更简单方案所获得的结果相似，我们不推荐我们的方案用于治疗小细胞肺癌。该疾病的最佳治疗方案尚未阐明。
