Feld R, Pringle J F, Evans W K, Keen C W, Quirt I C, Curtis J E, Baker M A, Yeoh J L, Deboer G, Brown T C
Arch Intern Med. 1981 Mar;141(4):469-73.
Ninety patients with extensive and 61 with limited small cell carcinoma of the lung were treated with three courses of intravenous chemotherapy (cyclophosphamide, doxorubicin hydrochloride, and vincristine sulfate) followed by radiotherapy to intrathoracic disease, and a second three-drug oral combination consisting of lomustine, procarbazine, and methotrexate for one year. Among the 147 patients who were evaluated, 55 of 66 (83%) with limited disease and 53 of 81 (65%) with extensive disease showed response after three courses of chemotherapy. The complete response rate in patients with limited disease prior to radiotherapy was 24%, but increased to 58% when evaluated following radiotherapy. The median survival was 47 weeks for patients with limited disease and 36 weeks for those with extensive disease. A 24% two-year survival is projected for complete responders. Important prognostic factors for survival are performance status, extent of disease, and sex, with female subjects doing somewhat better than male subjects. Among patients with limited disease, 45% failed within the CNS despite the use of chemotherapeutic agents that cross the blood-brain barrier. The initial induction regimen and radiotherapy were well tolerated; the oral three-drug combination was more toxic and did not prevent CNS metastases.
90例广泛期和61例局限期小细胞肺癌患者接受了三个疗程的静脉化疗（环磷酰胺、盐酸阿霉素和硫酸长春新碱），随后对胸腔内病灶进行放疗，并口服由洛莫司汀、丙卡巴肼和甲氨蝶呤组成的第二种三联药物组合，为期一年。在接受评估的147例患者中，66例局限期患者中有55例（83%）、81例广泛期患者中有53例（65%）在三个疗程化疗后出现反应。放疗前局限期患者的完全缓解率为24%，但放疗后评估时升至58%。局限期患者的中位生存期为47周，广泛期患者为36周。预计完全缓解者的两年生存率为24%。生存的重要预后因素包括体能状态、疾病范围和性别，女性患者的情况略好于男性患者。在局限期患者中，尽管使用了能穿过血脑屏障的化疗药物，但仍有45%的患者在中枢神经系统内出现病情进展。初始诱导方案和放疗耐受性良好；口服三联药物组合毒性更大，且不能预防中枢神经系统转移。
