Rice T W, Adelstein D J, Koka A, Tefft M, Kirby T J, Van Kirk M A, Taylor M E, Olencki T E, Peereboom D, Budd G T
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Ann Thorac Surg. 1995 Sep;60(3):586-91; discussion 591-2. doi: 10.1016/0003-4975(95)00457-V.
Induction therapy and resection may improve the survival of patients with poor prognosis stage III non-small cell lung cancer, at the cost of significant treatment prolongation. The purpose of this study was to assess toxicity, response, and survival of an accelerated induction regimen and resection in poor prognosis stage III non-small cell lung cancer.
Forty-two surgically staged patients with poor prognosis stage III non-small cell lung cancer received 11 days of induction treatment consisting of 96 hours of continuous chemotherapy infusions of cisplatin (20 mg.m-2.day-2), 5 fluorouracil (1,000 mg.m-2.day-2), and etoposide (75 mg.m-2.day-2) concurrent with accelerated fractionation radiation therapy (1.5 Gy twice a day, to a dose of 27 Gy). Induction was followed in 4 weeks by resection. Postoperatively, a second course of continuous chemotherapy and concurrent accelerated fractionation radiation therapy (postoperative dose 13 to 36 Gy) was given.
Despite some degree of induction toxicity in all patients there was only one induction death (2.4%). A clinical partial response was seen in 24 patients (57%). Thirty-six patients (86%) underwent thoracotomy, and resection was possible in 33 (79%). Pathologic downstaging was seen in 17 patients (40%), and 2 patients (5%) had no residual carcinoma at operation. There were 11 postoperative complications (31%) and 4 postoperative deaths (11%). Thirteen patients (31%) are alive and disease-free, 24 (57%) have persistent disease or have recurred (15 distant, 5 locoregional, 4 both), and 9 patients are alive with disease. The median survival is 21 months and the 2-year Kaplan-Meier survival is 43%, with no differences identified between stages IIIA and IIIB patients (p = 0.63).
We conclude that accelerated induction therapy and resection in poor prognosis stage III non-small cell lung cancer (1) is toxic, with a 12% treatment mortality; (2) is effective with a 79% resection rate and 40% pathologic downstaging rate; (3) provides excellent local control; (4) may prolong survival; and (5) is of value in stage IIIB as well as stage IIIA patients.
诱导治疗和手术切除可能会提高预后较差的III期非小细胞肺癌患者的生存率，但代价是显著延长治疗时间。本研究的目的是评估加速诱导方案及手术切除在预后较差的III期非小细胞肺癌中的毒性、反应和生存率。
42例经手术分期的预后较差的III期非小细胞肺癌患者接受了为期11天的诱导治疗，包括持续96小时输注顺铂（20mg·m⁻²·天⁻²）、5-氟尿嘧啶（1000mg·m⁻²·天⁻²）和依托泊苷（75mg·m⁻²·天⁻²），同时进行加速分割放疗（每天两次，每次1.5Gy，剂量达27Gy）。4周后进行诱导治疗后的手术切除。术后给予第二个疗程的持续化疗和同步加速分割放疗（术后剂量13至36Gy）。
尽管所有患者都有一定程度的诱导毒性，但只有1例诱导治疗死亡（2.4%）。24例患者（57%）出现临床部分缓解。36例患者（86%）接受了开胸手术，33例（79%）可行手术切除。17例患者（40%）出现病理降期，2例患者（5%）术中无残留癌。术后有11例并发症（31%），4例术后死亡（11%）。13例患者（31%）存活且无疾病，24例（57%）有持续性疾病或复发（远处转移15例、局部复发5例、两者皆有4例），9例患者带瘤存活。中位生存期为21个月，2年的Kaplan-Meier生存率为43%，IIIA期和IIIB期患者之间未发现差异（p = 0.63）。
我们得出结论，预后较差的III期非小细胞肺癌的加速诱导治疗和手术切除（1）具有毒性，治疗死亡率为12%；（2）有效，切除率为79%，病理降期率为40%；（3）提供了良好的局部控制；（4）可能延长生存期；（5）对IIIB期和IIIA期患者均有价值。
