Valdivieso M, Bodey G P, Benjamin R S, Barkley H T, Freeman M B, Ertel M, Smith T L, Mountain C F
Cancer Treat Rep. 1981;65 Suppl 5:145-50.
Forty-nine patients with small cell bronchogenic carcinoma (23 limited and 26 extensive disease) received their first two of three courses of intensive remission induction chemotherapy with (21 patients) or without (28 patients) intravenous hyperalimentation (IVH). The chemotherapy included six remission induction courses with ECHO (epipodophyllotoxin VP-16-213, cyclophosphamide, hydroxydaunorubicin, oncovin), followed by six courses of maintenance with PRIME (procarbazine, ifosfamide, methotrexate). Prophylactic brain irradiation (3000 r/2 weeks) was given to all patients and those with limited disease received chest irradiation (5000 r/5 weeks) at the completion of ECHO. Thus far, all 30 patients who have completed three courses of ECHO have responded with complete (70% CR) or partial (30% PR) remissions. The CR rate was higher for patients receiving IVH (85% vs 59%, P = 0.25). Myelosuppression was pronounced and predominantly in the form of neutropenia. Median lowest neutrophil counts were zero during each of the three courses of ECHO and lasted a median of 5 days at levels less than 500/mm3. Major infections occurred in 21% of courses. The administration of IVH did not ameliorate the hematologic, gastrointestinal, and infectious morbidity of ECHO chemotherapy. However, it resulted in preservation of body weight (P less than 0.01) and improved skin reactivity to a battery of six skin antigens (P = 0.03). The administration of intensive therapy with ECHO +/- IVH was well tolerated and resulted in high CR rates in patients with small cell bronchogenic carcinoma. The administration of IVH was most helpful in preventing severe weight loss and augmenting response to a battery of skin antigens. The long term survival effects of these observations are yet to be determined.
49例小细胞支气管肺癌患者（23例局限性疾病和26例广泛性疾病）接受了三个疗程强化缓解诱导化疗中的前两个疗程，其中21例患者接受了静脉高营养（IVH），28例患者未接受静脉高营养。化疗包括六个疗程的ECHO方案（表鬼臼毒素VP-16-213、环磷酰胺、羟基柔红霉素、长春新碱）诱导缓解，随后是六个疗程的PRIME方案（丙卡巴肼、异环磷酰胺、甲氨蝶呤）维持治疗。所有患者均接受预防性脑照射（3000r/2周），局限性疾病患者在ECHO方案结束时接受胸部照射（5000r/5周）。迄今为止，所有完成三个疗程ECHO方案的30例患者均有完全缓解（70%CR）或部分缓解（30%PR）。接受IVH的患者CR率更高（85%对59%，P=0.25）。骨髓抑制明显，主要表现为中性粒细胞减少。在ECHO方案的三个疗程中，每个疗程中性粒细胞计数最低中位数均为零，低于500/mm3的水平持续中位数为5天。21%的疗程发生了严重感染。IVH的使用并未改善ECHO化疗的血液学、胃肠道和感染性发病率。然而，它导致体重得以维持（P<0.01），并改善了对一组六种皮肤抗原的皮肤反应性（P=0.03）。ECHO±IVH强化治疗耐受性良好，小细胞支气管肺癌患者的CR率较高。IVH的使用在预防严重体重减轻和增强对一组皮肤抗原的反应方面最有帮助。这些观察结果对长期生存的影响尚待确定。
