Cox J D, Holoye P Y, Byhardt R W, Libnoch J A, Komaki R, Hansen R M, Kun L E, Anderson T
Int J Radiat Oncol Biol Phys. 1982 Feb;8(2):191-6. doi: 10.1016/0360-3016(82)90513-2.
Since 1974, 120 previously untreated patients with small cell carcinoma of the lung seen in Therapeutic Radiology at The Medical College of Wisconsin have been entered into one of 4 successive studies. Study I used thoracic irradiation (TI) alone (4500-6000 rad in 3-6 weeks) with chemotherapy at progression. Study II randomized patients with limited disease to TI (3000 rad in 2 weeks) plus either cyclophosphamide, doxorubicin, vincristine (CAV) or total body irradiation (TBI); patients with extensive disease received TI + CAV. Study III employed prophylactic cranial irradiation (PCI) plus CAV and withheld TI unless there was incomplete response or recurrence. Of 93 evaluable patients from the first three studies, 55 had limited and 38 extensive disease. Study I (37 patients) showed a 62% complete response (CR) rate; 43% failed in the chest, 14% had brain metastases, and the median survival was only 22 weeks in spite of a preponderance of limited disease patients. Study II (27 patients) showed a CR of 59%; 30% had brain metastases and the median survival was 48 weeks. Study II patients (29) had a 69% rate; 72% failed in the chest, 4% with PCI developed brain metastases, and the median survival was 50 weeks. In March, 1979, Study IV was initiated; patients receive PCI (2500 rad in 2 weeks) plus high dose CAV, methotrexate and leucovorin. After 6 cycles, consolidation TI (3750 rad in 3 weeks) is given to patients with complete response. Preliminary results with 27 patients treated on this study show a 67% CR rate, a 41% chest failure rate (but only 11% for the patients who received thoracic irradiation) and no intracranial failures, but a 13% extracranial CNS failure rate. PCI, TI and spinal irradiation may be necessary to maximize the probability of long term disease free survival.
自1974年以来，威斯康星医学院放射治疗科收治的120例未经治疗的小细胞肺癌患者被纳入4项连续研究之一。研究I单独使用胸部照射（TI）（3至6周内4500 - 6000拉德），病情进展时加用化疗。研究II将局限性疾病患者随机分为TI（2周内3000拉德）加环磷酰胺、阿霉素、长春新碱（CAV）或全身照射（TBI）组；广泛性疾病患者接受TI + CAV治疗。研究III采用预防性颅脑照射（PCI）加CAV，除非有不完全缓解或复发，否则不进行TI。在前三项研究的93例可评估患者中，55例为局限性疾病，38例为广泛性疾病。研究I（37例患者）的完全缓解（CR）率为62%；43%的患者胸部复发，14%有脑转移，尽管局限性疾病患者占多数，但中位生存期仅22周。研究II（27例患者）的CR率为59%；30%有脑转移，中位生存期为48周。研究II的患者（29例）CR率为69%；72%的患者胸部复发，接受PCI的患者中有4%发生脑转移，中位生存期为50周。1979年3月启动了研究IV；患者接受PCI（2周内2500拉德）加高剂量CAV、甲氨蝶呤和亚叶酸钙。6个周期后，对完全缓解的患者给予巩固性TI（3周内3750拉德）。该研究中27例患者的初步结果显示CR率为67%，胸部复发率为41%（但接受胸部照射的患者仅为11%），无颅内复发，但颅外中枢神经系统复发率为13%。PCI、TI和脊髓照射可能是使长期无病生存概率最大化所必需的。
