Turrisi A T
Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor.
Chest. 1993 Jan;103(1 Suppl):56S-59S.
Recent approaches to the treatment of limited small-cell lung cancer have combined local radiotherapy and systemic chemotherapy in an attempt to improve local control and inhibit distant metastases. Local control is a key indicator of the efficacy of radiotherapy administration in combined-modality regimens. However, even in combined-modality trials using high total radiotherapy doses, local failure rates have ranged from 30 to 50 percent. The components of radiotherapy administration--including dose, volume, fractionation, integration with chemotherapy (concurrent, alternating, or sequential), and timing (early or late administration)--are also important considerations. Hyperfractionation, or the administration of small fractions of radiation more than once daily (usually twice), and accelerated hyperfactionation, or the administration of three fourths of the standard radiation dose two to three times daily, have emerged as important concepts in radiotherapy. Although the optimal chemotherapy regimen for combined-modality treatment has not yet been established, use of cisplatin and etoposide combinations, which do not promote pulmonary, cardiac, or esophageal toxicity, have been particularly appropriate in patients with small-cell lung cancer.
近期，针对局限性小细胞肺癌的治疗方法是将局部放疗与全身化疗相结合，以期提高局部控制率并抑制远处转移。局部控制是联合治疗方案中放疗疗效的关键指标。然而，即便在采用高总放疗剂量的联合治疗试验中，局部失败率仍在30%至50%之间。放疗实施的各个要素——包括剂量、体积、分割方式、与化疗的联合方式（同步、交替或序贯）以及时机（早期或晚期实施）——也是重要的考量因素。超分割放疗，即每日多次给予小剂量辐射（通常为两次），以及加速超分割放疗，即每日两至三次给予标准放疗剂量的四分之三，已成为放疗领域的重要概念。尽管联合治疗的最佳化疗方案尚未确立，但使用顺铂和依托泊苷联合方案对小细胞肺癌患者尤为合适，因为该方案不会引发肺部、心脏或食管毒性。
