Byhardt R W, Cox J D, Libnoch J A, Komaki R, Holoye P Y, Anderson T
Am J Clin Oncol. 1985 Dec;8(6):504-11. doi: 10.1097/00000421-198512000-00010.
Between 6/81 and 6/83, 73 patients with small cell carcinoma of the lung were treated according to a prospective protocol in which cyclophosphamide, doxorubicin, and vincristine (CAV) were given concurrently with prophylactic craniocervical irradiation to the level of C5. Both limited and extensive disease patients with normal computed tomography of the brain received 25 Gy in 10 fractions in 2 weeks. Complete responders to CAV received consolidative thoracic irradiation (CTI) to the local-regional primary (37.5 Gy in 15 fractions in 3 weeks), the first 25 Gy in 10 fractions serving as prophylaxis of the C6 to T12 spinal cord. The neuraxis from L1 to S2 then received 25 Gy in 10 fractions in 2 weeks. Consolidative irradiation of localizable metastatic sites was given in extensive disease patients. Partial and nonresponders to CAV received 50-60 Gy in 5-6 weeks to local-regional disease. With a median followup of 29 months, survival was significantly better (p less than .01) in patients receiving CTI to the chest after complete response to CAV (both limited disease and extensive disease) than without CTI. Of 41 patients completing the protocol and without central nervous system (CNS) involvement at presentation, four (9%) failed initially in the CNS (two brain, two spinal axis); CNS failure was the cause of death in all four patients with no other sites of metastases at death in two of these. Failure to complete protocol treatment was due to disease progression during chemotherapy in 25/73 (34%) and chemotherapy related complications (three sepsis, one gastrointestinal bleed) in four of 73 (5.5%) patients. CTI and prophylactic neuraxis irradiation did not increase morbidity or result in mortality in the sequence utilized; prophylactic neuraxis irradiation appears to reduce the CNS relapse rate, and CTI benefits survival.
在1981年6月至1983年6月期间，73例肺小细胞癌患者按照一项前瞻性方案接受治疗，该方案中，环磷酰胺、阿霉素和长春新碱（CAV）与预防性颅颈照射至C5水平同时给予。脑计算机断层扫描正常的局限性和广泛性疾病患者在2周内分10次接受25 Gy照射。对CAV完全缓解的患者接受针对局部区域原发灶的巩固性胸部照射（CTI）（3周内分15次给予37.5 Gy），前10次给予的25 Gy用于预防C6至T12脊髓。然后，L1至S2的神经轴在2周内分10次接受25 Gy照射。广泛性疾病患者接受可定位转移部位的巩固性照射。对CAV部分缓解和无反应的患者，对局部区域疾病在5至6周内给予50 - 60 Gy照射。中位随访29个月，对CAV完全缓解后接受胸部CTI的患者（局限性疾病和广泛性疾病患者）的生存率显著高于未接受CTI的患者（p小于0.01）。在41例完成方案且初诊时无中枢神经系统（CNS）受累的患者中，4例（9%）最初在CNS出现失败（2例脑部，2例脊髓轴）；CNS失败是所有4例患者的死亡原因，其中2例患者死亡时无其他转移部位。未能完成方案治疗的原因是25/73（34%）的患者在化疗期间疾病进展，以及73例患者中有4例（5.5%）出现化疗相关并发症（3例败血症，1例胃肠道出血）。按照所采用的顺序，CTI和预防性神经轴照射并未增加发病率或导致死亡；预防性神经轴照射似乎可降低CNS复发率，且CTI对生存有益。
