Shaw E G, Frytak S, Eagan R T, Richardson R L, Creagan E T, Jett J R, Foote R L, Su J Q, Schaid D J, Lee R E
Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Am J Clin Oncol. 1996 Apr;19(2):154-8. doi: 10.1097/00000421-199604000-00013.
Our purpose was to determine the ability of an etoposide-cisplatin (EP )-based regimen to salvage patients with limited and extensive small-cell lung cancer who are incomplete responders to cyclophosphamide-Adriamycin-vincristine-etoposide (CAVE) chemotherapy, and to determine the ability of thoracic radiation therapy (TRT) to salvage CAVE and EP incomplete responders. Fifty-eight patients with small-cell lung cancer (33, limited disease; 25, extensive disease) were entered on this Phase II study between November 1984 and December 1987. Patients received three cycles of CAVE chemotherapy, followed by two cycles of CEPi (cyclophosphamide-etoposide-cisplatin (infusional) and two cycles of CE (cyclophosphamide-etoposide) in conjunction with TRT and prophylactic cranial irradiation (PCI). The overall response rate to CAVE was 62% [5% complete response (CR), 57% partial response (PR) + regression (REGR)]. Of the patients who failed to achieve a CR with CAVE, 81% responded to CEPi (44% CR, 36% PR). Of the patients who did not achieve a CR with either CAVE or CEPi, 89% responded to TRT (65% CR, 24% PR + REGR). For the 33 patients with limited disease, the median survival time and 2-year survival rate were 16.1 months and 24%, respectively. The corresponding figures for the 25 patients with extensive disease were 9.8 months and 4%, respectively. Eleven of these 25 patients were "downstaged" to "limited disease" with CAVE + CEPi and then received TRT + PCI + CE. Their median survival time and 2-year survival rate were 12.6 months and 9%, respectively. The EP-based regimen CEPi and TRT were able to convert 44 to 65% of patients to a complete response who had failed to do so with non-EP induction chemotherapy. This study supports the use of an EP regimen with TRT as initial therapy for newly diagnosed small-cell lung cancer.
我们的目的是确定基于依托泊苷和顺铂（EP）的方案挽救对环磷酰胺-阿霉素-长春新碱-依托泊苷（CAVE）化疗反应不完全的局限性和广泛性小细胞肺癌患者的能力，以及确定胸部放射治疗（TRT）挽救CAVE和EP反应不完全患者的能力。1984年11月至1987年12月期间，58例小细胞肺癌患者（33例局限性疾病；25例广泛性疾病）进入了这项II期研究。患者接受三个周期的CAVE化疗，随后是两个周期的CEPi（环磷酰胺-依托泊苷-顺铂（静脉滴注））和两个周期的CE（环磷酰胺-依托泊苷）联合TRT和预防性颅脑照射（PCI）。对CAVE的总体缓解率为62%[5%完全缓解（CR），57%部分缓解（PR）+病情稳定（REGR）]。在未通过CAVE达到CR的患者中，81%对CEPi有反应（44%CR，36%PR）。在未通过CAVE或CEPi达到CR的患者中，89%对TRT有反应（65%CR，24%PR+REGR）。对于33例局限性疾病患者，中位生存时间和2年生存率分别为16.1个月和24%。25例广泛性疾病患者的相应数据分别为9.8个月和4%。这25例患者中有11例通过CAVE+CEPi“降期”为“局限性疾病”，然后接受TRT+PCI+CE。他们的中位生存时间和2年生存率分别为12.6个月和9%。基于EP的方案CEPi和TRT能够将44%至65%未通过非EP诱导化疗达到完全缓解的患者转化为完全缓解。这项研究支持使用EP方案联合TRT作为新诊断小细胞肺癌的初始治疗方法。
