Lindén C J, Mercke C, Albrechtsson U, Johansson L, Ewers S B
Dept. of Lung Medicine, University Hospital, Lund, Sweden.
Eur Respir J. 1996 Dec;9(12):2565-72. doi: 10.1183/09031936.96.09122565.
In order to assess the value of radiotherapy in the treatment of pleural mesotheliomas, we studied tumour response and survival after hemithorax irradiation alone (RT), or radiotherapy combined with doxorubicin and cyclophosphamide chemotherapy (RTCT). Forty seven patients with pleural mesotheliomas received irradiation of the diseased hemithorax at 8 MV (megavolt) photons to a total dose of 40 Gy, administered in 20 daily fractions of 2 Gy for 5 days a week. One month after RT, patients aged < or = 70 yrs with a good performance status were offered supplementary chemotherapy (CT) with doxorubicin 30 mg.m-2 body surface on Day 1 and Day 8, combined with cyclophosphamide 600 mg.m-2 on Day 1, in cycles of 21 days. Tumour response was evaluated by computed axial tomography (CAT) before and 1 month after RT and/or CT. Only 3 of the 47 (95% confidence interval (95% CI)-0.6-13%) irradiated tumours responded with a partial response (PR). In 31 patients treated with RT alone, one PR was observed; whereas, in the combined treatment group, 2 out of 16 responded with PR to RT. CT with doxorubicin and cyclophosphamide induced only 2 out of 16 PRs (95% CI -3.4-28.4%), and the combined treatment consisting of RT followed by CT induced 2 out of 16 PRs. The median survival following the initiation of RT was 7 months in all patients (n = 47), 6 months in the RT group (n = 31), and 13 months in the combined RTCT group (n = 16). Chest pain, performance status and body weight were not favourably affected by the radiotherapy. We conclude that hemithorax irradiation of pleural mesotheliomas with a moderately high dose is not useful, since it produces no improvement in chest pain, few objective tumour responses and no prolongation of survival.
为了评估放射治疗在胸膜间皮瘤治疗中的价值，我们研究了单纯半胸照射（RT）或放射治疗联合阿霉素和环磷酰胺化疗（RTCT）后的肿瘤反应和生存率。47例胸膜间皮瘤患者接受了以8兆伏光子对患侧半胸进行照射，总剂量为40 Gy，每周5天，每天2 Gy，分20次给予。放疗后1个月，对年龄≤70岁、身体状况良好的患者给予补充化疗（CT），阿霉素30 mg·m⁻²体表面积于第1天和第8天给药，环磷酰胺600 mg·m⁻²于第1天给药，每21天为一个周期。在放疗和/或化疗前及1个月后通过计算机断层扫描（CAT）评估肿瘤反应。47例接受照射的肿瘤中只有3例（95%置信区间（95%CI）-0.6-13%）出现部分缓解（PR）。在31例仅接受放疗的患者中，观察到1例PR；而在联合治疗组中，16例中有2例对放疗有PR反应。阿霉素和环磷酰胺化疗仅在16例中诱导出2例PR（95%CI -3.4-28.4%），放疗后接着化疗的联合治疗在16例中诱导出2例PR。所有患者（n = 47）放疗开始后的中位生存期为7个月，放疗组（n = 31）为6个月，联合RTCT组（n = 16）为13个月。胸痛、身体状况和体重未受到放疗的不利影响。我们得出结论，对胸膜间皮瘤进行中等高剂量的半胸照射并无用处，因为它并未改善胸痛，客观肿瘤反应极少，也未延长生存期。
