Müller G, Kiricuta I C, Stiess J, Flentje M
Klinik für Strahlentherapie, Universität Würzburg.
Strahlenther Onkol. 1996 Aug;172(8):446-54.
To investigate the survival of patients with inoperable non-small-cell lung cancer treated with combined radiochemotherapy. Frequency of local progression versus systemic dissemination after radiotherapy respectively radiochemotherapy. Extend of the toxicity of a combined modality treatment.
60 inoperable patients (42 M0- and 18 M1-stage) with non-small-cell lung cancer who had received combined radiochemotherapy (RT+CT) were examined retrospectively. Different drugs or drug combinations were used. The sequence of radiotherapy and chemotherapy also differed. The survival was compared to that of another group of patients who had received at least 50 Gy with definitive radiotherapy at the same period of time (RT: N = 135). The Karnofsky performance index (KPI) was on an average of 80% in both groups. The primary of patients with systemic disease was treated by radiation when it became symptomatic or when it showed an evident progression.
The two investigated treatment groups were comparable regarding KPI, histology, stage, tumor dose and age. The survival was significantly better when chemotherapy was added to radiotherapy. The median survival times in months were as follows: M0: RT 10.6/RT+CT 14.7; M1: RT 6.0/ RT+CT 9.3. Local tumor control was the major problem with or without chemotherapy (local progression of about 70% in both groups). The toxicity of radiochemotherapy was acceptable (bone marrow toxicity WHO-grade 4: 10.5%: nausea WHO-grade 4: 3%).
In the absence of medical contraindications and with a KPI of at least 70% a combined radiochemotherapy in patients with inoperable non-small-cell lung cancer seems to be possible even if high radiation doses are used. Randomized studies are necessary to prove the impact on survival of an additional chemotherapy.
研究接受放化疗联合治疗的不可切除非小细胞肺癌患者的生存率。放疗及放化疗后局部进展与全身播散的频率。联合治疗方式的毒性程度。
回顾性研究60例接受放化疗联合治疗（放疗+化疗）的不可切除非小细胞肺癌患者（42例M0期和18例M1期）。使用了不同的药物或药物组合。放疗和化疗的顺序也有所不同。将生存率与同期接受至少50 Gy根治性放疗的另一组患者（放疗组：N = 135）进行比较。两组患者的卡诺夫斯基功能状态评分（KPI）平均均为80%。有全身疾病的患者在出现症状或明显进展时接受放疗。
两个研究治疗组在KPI、组织学、分期、肿瘤剂量和年龄方面具有可比性。放疗联合化疗时生存率显著提高。以月为单位的中位生存时间如下：M0期：放疗组10.6/放化疗联合组14.7；M1期：放疗组6.0/放化疗联合组9.3。无论有无化疗，局部肿瘤控制都是主要问题（两组局部进展率均约为70%）。放化疗的毒性可以接受（骨髓毒性WHO 4级：10.5%；恶心WHO 4级：3%）。
在没有医学禁忌证且KPI至少为70%的情况下，即使使用高剂量放疗，不可切除非小细胞肺癌患者似乎也可以进行放化疗联合治疗。需要进行随机研究以证明额外化疗对生存率的影响。
