Nishiwaki Y, Nagai K, Kodama T, Nishiyama H, Hojo H, Matsumoto T
Department of Respiratory Disease, National Cancer Center Hospital East.
Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Dec;31 Suppl:203-11.
The postoperative survival of patients with preoperatively identified stage III N2 non-small cell cancer (NSCLC) is poor. A pilot study of induction chemotherapy consisting of cisplatin, mitomycin C and vindesine (CMV) was undertaken in an attempt to improve the curative potential of surgery in this group of patients.
Thirty-two patients with stage III N2a NSCLC received two cycles of CMV, (80 mg/m2 cisplatin i.v. on day 1, 8 mg/m2 mitomycin C i.v. on day 1, and 3 mg/m2 vindesine i.v. on day 1 and 8, every 4 weeks) preoperatively. The responding patients received a further two courses of CMV after surgery.
The response rate was 63% (20 PR). All patients underwent operation including radical mediastinal node dissection. Twenty-six resections were curative and six were absolute non-curative. The toxicity was generally mild, but there were two hospital deaths, due to bronchopleural fistula and postoperative pneumonia. Sixteen patients have shown recurrent disease up to now. When the recurrence patterns were classified by clinical response, 11 responding patients were disease-free (9-84 months), but all non-responding patients had recurrent diseases. The median survival of curatively resected patients with pathological N2 was 39 months with a 5-year survival of 29%.
This induction chemotherapy was well tolerated and revealed a high response rate. The current survival is obviously improved compared with the historical control, indicating that subsequent phase III clinical trials are urgently needed.
术前确诊为Ⅲ期N2非小细胞肺癌（NSCLC）患者的术后生存率较低。开展了一项由顺铂、丝裂霉素C和长春地辛（CMV）组成的诱导化疗的初步研究，试图提高该组患者手术的治愈潜力。
32例Ⅲ期N2a NSCLC患者术前接受两个周期的CMV化疗（第1天静脉注射顺铂80mg/m²，第1天静脉注射丝裂霉素C 8mg/m²，第1天和第8天静脉注射长春地辛3mg/m²，每4周一次）。有反应的患者术后再接受两个疗程的CMV化疗。
缓解率为63%（20例部分缓解）。所有患者均接受了手术，包括根治性纵隔淋巴结清扫术。26例切除为根治性，6例为绝对非根治性。毒性一般较轻，但有2例医院死亡，原因是支气管胸膜瘘和术后肺炎。截至目前，16例患者出现复发。当根据临床反应对复发模式进行分类时，11例有反应的患者无疾病复发（9 - 84个月），但所有无反应的患者均出现复发。病理N2的根治性切除患者的中位生存期为39个月，5年生存率为29%。
这种诱导化疗耐受性良好，缓解率高。与历史对照相比，目前的生存率明显提高，表明迫切需要开展后续的Ⅲ期临床试验。
