Aida Yuka, Nakazawa Kensuke, Shiozawa Toshihiro, Ogawa Ryoko, Kiwamoto Takumi, Morishima Yuko, Sakamoto Toru, Sekine Ikuo, Hizawa Nobuyuki
Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Case Rep Oncol. 2019 Aug 6;12(2):613-620. doi: 10.1159/000501548. eCollection 2019 May-Aug.
Small-cell lung cancer (SCLC) is highly sensitive to platinum-based chemotherapy. However, its indication in patients with a poor performance status (PS) at initial diagnosis is controversial. We retrospectively reviewed all clinical courses of pathologically diagnosed SCLC patients with poor PS, Eastern Cooperative Oncology Group PS 3 and 4. Among 18 patients, 12 were treated with chemotherapy and 6 with supportive care alone. During the chemotherapy courses, PS improved in 7 (58.3%, including the PS 4 cases), remained stable in 2 (16.7%), and deteriorated in 3 (25%) patients. Moreover, 5 patients showed partial responses to chemotherapy (response rate of 41.7%). Grade 3-4 neutropenia developed in 10 (83.3%) patients and grade 3 febrile neutropenia occurred in 5 (41.7%) patients, but no grade 4 non-hematological toxicity was noted. Mortality associated with lung toxicity (grade 5) due to treatment occurred in a 77-year-old-male patient with PS 3. No substantial difference in survival was observed between patients with PS 3 and 4, even when including those treated with supportive care alone. Treatment had a positive effect on survival: after chemotherapy, the 6-month survival rate of PS 3 and 4 patients was 66.7%. In contrast, all patients treated with supportive care alone died within 5 months. These findings suggest that chemotherapy is indicated in selected SCLC patients not only with PS 3, but also with PS 4.
小细胞肺癌（SCLC）对铂类化疗高度敏感。然而，其在初诊时体能状态（PS）较差的患者中的应用存在争议。我们回顾性分析了所有经病理诊断为PS较差（东部肿瘤协作组PS 3和4）的SCLC患者的临床病程。18例患者中，12例接受了化疗，6例仅接受了支持治疗。在化疗过程中，7例（58.3%，包括PS 4的病例）患者的PS得到改善，2例（16.7%）保持稳定，3例（25%）患者的PS恶化。此外，5例患者对化疗有部分反应（反应率为41.7%）。10例（83.3%）患者发生3 - 4级中性粒细胞减少，5例（41.7%）患者发生3级发热性中性粒细胞减少，但未观察到4级非血液学毒性。一名77岁、PS 3的男性患者因治疗出现肺部毒性（5级）相关死亡。PS 3和PS 4的患者在生存方面未观察到显著差异，即使包括仅接受支持治疗的患者。治疗对生存有积极影响：化疗后，PS 3和PS 4患者的6个月生存率为66.7%。相比之下，所有仅接受支持治疗的患者在5个月内死亡。这些发现表明，化疗不仅适用于部分PS 3的SCLC患者，也适用于PS 4的患者。
