Goodman G E, Miller T P, Manning M M, Davis S L, McMahon L J
J Clin Oncol. 1983 Aug;1(8):483-8. doi: 10.1200/JCO.1983.1.8.483.
Seventy-one previously untreated patients with small cell lung cancer (SCLC) received a combination of VP-16, vincristine, doxorubicin (Adriamycin), and cyclophosphamide (EVAC) repeated every three weeks. Limited-disease (LD) patients and extensive-disease (ED) patients achieving a complete response (CR) or partial response (PR) after four to six cycles of EVAC received 4,000 rads over four weeks whole-brain radiotherapy (RT) and 5,000 rads over five weeks RT to the original pulmonary primary and mediastinum. ED patients with persisting disease outside the chest after six cycles of EVAC continued chemotherapy and did not receive RT. After RT was completed, EVAC was continued for a total treatment duration of 24 months. Of 65 patients evaluable for response 76% (25 of 33) of LD patients and 34% (11 of 32) of ED patients achieved a CR prior to RT; two additional ED patients achieved a CR after RT. Median survival for all 71 patients was 48 weeks (range, one to 207 weeks); median survival for 33 LD patients was 92 weeks and for 38 ED patients it was 36 weeks. Nine of 25 LD patients and 10 of 13 ED patients have relapsed from CR. The EVAC-RT protocol is promising in view of the high CR rate and long remission duration achieved, especially among patients with LD.
71例既往未接受过治疗的小细胞肺癌（SCLC）患者接受了依托泊苷、长春新碱、阿霉素和环磷酰胺（EVAC）联合治疗，每3周重复一次。局限期（LD）患者和广泛期（ED）患者在接受4至6周期的EVAC治疗后达到完全缓解（CR）或部分缓解（PR），随后在4周内接受全脑放疗（RT）4000拉德，并在5周内对原肺部原发灶和纵隔给予5000拉德的放疗。6周期EVAC治疗后胸部外仍有持续性疾病的ED患者继续化疗，未接受放疗。放疗完成后，继续使用EVAC治疗，总疗程为24个月。在65例可评估缓解情况的患者中，76%（33例中的25例）的LD患者和34%（32例中的11例）的ED患者在放疗前达到CR；另外2例ED患者在放疗后达到CR。所有71例患者的中位生存期为48周（范围为1至207周）；33例LD患者的中位生存期为92周，38例ED患者的中位生存期为36周。25例LD患者中有9例、13例ED患者中有10例从CR状态复发。鉴于所取得的高CR率和长缓解期，尤其是在LD患者中，EVAC-RT方案很有前景。
