Choi N C, Carey R W, Kaufman S D, Grillo H C, Younger J, Wilkins E W
Cancer. 1987 Jan 1;59(1):6-14. doi: 10.1002/1097-0142(19870101)59:1<6::aid-cncr2820590106>3.0.co;2-t.
To assess the results of therapeutic advances in the treatment of small cell carcinoma of the lung (SCCL) achieved during the past 15-year period at a single large institution, 508 patients treated between 1968 and 1982 were divided into two groups: 157 patients (66 in the category of limited-stage disease and 91 in the extensive-stage disease category) treated with low-dose small-volume radiotherapy (RT) (time dose fractionation [TDF] 49-66) and with cyclophosphamide alone or a COPP program during the first period of 7 years (1968-1974); 351 patients (180 in limited and 171 in extensive stage) treated with multidrug chemotherapy (CT) and high-dose large-volume RT (TDF 73-89) during the second period of 8 years (1975-1982). For patients with limited-stage cancer, 5-year actuarial survivals were 3% versus 7% for the periods 1968-1974 versus 1975-1982, respectively, P less than 0.01. For patients with extensive-stage cancer, the median survival time (MST) and 2-year actuarial survivals were 5 months and 2% versus 7 months and 4% for the periods 1968-1974 versus 1975-1982, respectively. To evaluate the outcome of a contemporary approach, i.e., CT alone, with RT reserved for locoregional failure, 180 patients with limited-stage cancer who were treated (1975-1982) were further analyzed for MST, 2- and 5-year actuarial survival figures, and local-tumor control rates according to the therapeutic approaches employed: CT + RT (112); CT alone (36); RT alone (17); and surgery (S) +/- CT +/- RT (15). Although the 36 patients in CT alone seems a small number, 17 of the 36 patients were enrolled in this approach in 1981-1982, reflecting a shift of emphasis from RT to CT. The MST and 2-year actuarial survival figures were 11 months and 0% versus 13 months and 21% for CT alone versus CT + RT respectively, P less than 0.05. CT + RT achieved a 5-year cure rate of 8%. S +/- CT +/- RT or RT alone also achieved 5-year cure rates of 8% and 10.5%, respectively, in selected subsets of patients. Local relapse rates were 80% (29/36) versus 25% (28/112) for CT alone versus CT + RT. These data emphasize the importance of thoracic RT given at the early phase of treatment to improve long-term survival for patients with limited-stage SCCL.
为评估在一家大型机构过去15年期间肺癌小细胞癌（SCCL）治疗方面的进展成果，将1968年至1982年期间接受治疗的508例患者分为两组：157例患者（66例为局限期疾病，91例为广泛期疾病）在最初7年（1968 - 1974年）接受低剂量小体积放疗（RT）（时间剂量分割[TDF]49 - 66），并单独使用环磷酰胺或采用COPP方案；351例患者（180例为局限期，171例为广泛期）在接下来8年（1975 - 1982年）接受多药化疗（CT）和高剂量大体积RT（TDF 73 - 89）。对于局限期癌症患者，1968 - 1974年期间与1975 - 1982年期间的5年精算生存率分别为3%和7%，P小于0.01。对于广泛期癌症患者，1968 - 1974年期间与1975 - 1982年期间的中位生存时间（MST）和2年精算生存率分别为5个月和2%以及7个月和4%。为评估一种当代治疗方法的结果，即单纯CT治疗，RT仅用于局部区域失败情况，对1975 - 1982年期间接受治疗的180例局限期癌症患者，根据所采用的治疗方法进一步分析其MST、2年和5年精算生存数据以及局部肿瘤控制率：CT + RT（112例）；单纯CT（36例）；单纯RT（17例）；手术（S）+/- CT +/- RT（15例）。虽然单纯CT治疗的36例患者数量似乎较少，但其中17例患者是在1981 - 1982年纳入该治疗方法的，这反映出治疗重点从RT向CT的转变。单纯CT与CT + RT的MST和2年精算生存率分别为11个月和0%以及13个月和21%，P小于0.05。CT + RT实现了8%的5年治愈率。在选定的患者亚组中，S +/ - CT +/ - RT和单纯RT也分别实现了8%和10.5%的5年治愈率。单纯CT与CT + RT的局部复发率分别为80%（29/36）和25%（28/112）。这些数据强调了在治疗早期给予胸部RT对于提高局限期SCCL患者长期生存率的重要性。
