Bardet E, Rivière A, Charloux A, Spaeth D, Ducoloné A, Le Groumellec A, Pellae-Cosset B, Henry-Amar M, Douillard J Y
Centre René Gauducheau, Nantes, France.
Int J Radiat Oncol Biol Phys. 1997 Apr 1;38(1):163-8. doi: 10.1016/s0360-3016(97)00254-x.
To evaluate feasibility and efficacy of concomitant radiochemotherapy (CRCT) in Stage IIIB nonsmall-cell lung cancer (NSCLC), two induction chemotherapy cycles combining etoposide and carboplatin were first delivered, followed by CRCT with daily radiation fraction in association with carboplatin.
Forty patients with biopsy-proven, locally advanced unresectable nonmetastatic NSCLC were enrolled. Induction chemotherapy consisted of two cycles (day 1 and day 28) of etoposide (VP16:100 mg/m2, days 1 to 3) and carboplatin (CBDCA:350 mg/m2, day 1). Irradiation starting at day 56, delivered 66 Gy in 2 Gy daily fraction, 5 days a week, along with a daily dose of CBDCA (15 mg/m2) given intravenously 2 to 4 h before radiation. In nonprogressive patients under induction chemotherapy, two additional cycles of VP16-CBDCA were administered 4 weeks after the completion of CRCT.
Out of the 40 patients enrolled (38 males, 2 females), 37 (93%) received induction chemotherapy as scheduled, with 38% Grade 3-4 hematological toxicity. Response rate to induction chemotherapy was 11% (4/37). No tumor became resectable. CRCT was delivered to 32 of these 37 patients, with full doses given to 91% of them. Clinical and hematological Grade 3-4 toxicity rates were 21 and 13%, respectively. Additional chemotherapy was delivered in 12 of 26 nonprogressive patients. At final evaluation, performed 3 months after the end of CRCT, 38% of 26 evaluable patients were responders (4 complete and 6 partial), leading to a 25% (10 of 40) overall objective response rate. Of these 10 responders, 8 became responders after CRCT only. Overall, the 1-year local control rate was 28% (11 of 40). The median survival time was 9 months and the 1-year and 2-year overall survival rates were 38 and 15%, respectively. Thirty-six patients died from local progression (25 patients), distant metastasis (9 patients), or pulmonary fibrosis (2 patients).
Concomitant CRCT with CBDCA is feasible with acceptable induction chemotherapy-related toxicity and a 1-year local control rate of 28%. Response rate to induction chemotherapy was low and better chemotherapy combination should be used to reduce distant failure probability and to improve local response rate before CRCT.
为评估同步放化疗（CRCT）用于ⅢB期非小细胞肺癌（NSCLC）的可行性和疗效，首先给予两个周期的依托泊苷联合卡铂诱导化疗，随后进行CRCT，采用每日分次放疗联合卡铂。
40例经活检证实为局部晚期不可切除的非转移性NSCLC患者入组。诱导化疗包括两个周期（第1天和第28天）的依托泊苷（VP16：100mg/m²，第1至3天）和卡铂（CBDCA：350mg/m²，第1天）。放疗从第56天开始，每周5天，每天2Gy，共给予66Gy，同时在放疗前2至4小时静脉给予每日剂量的CBDCA（15mg/m²）。在诱导化疗期间病情无进展的患者中，CRCT完成后4周再给予两个周期的VP16-CBDCA。
入组的40例患者（38例男性，2例女性）中，37例（93%）按计划接受了诱导化疗，3-4级血液学毒性发生率为38%。诱导化疗的缓解率为11%（4/37）。无肿瘤变为可切除。这37例患者中有32例接受了CRCT，其中91%的患者接受了全剂量治疗。临床和血液学3-4级毒性发生率分别为21%和13%。26例病情无进展的患者中有12例接受了追加化疗。在CRCT结束后3个月进行最终评估时，26例可评估患者中有38%为缓解者（4例完全缓解和6例部分缓解），总体客观缓解率为25%（40例中的10例）。在这10例缓解者中，8例仅在CRCT后成为缓解者。总体而言，1年局部控制率为28%（40例中的11例）。中位生存时间为9个月，1年和2年总生存率分别为38%和15%。36例患者死于局部进展（25例）、远处转移（9例）或肺纤维化（2例）。
同步CRCT联合CBDCA是可行的，诱导化疗相关毒性可接受，1年局部控制率为28%。诱导化疗的缓解率较低，应采用更好的化疗方案组合来降低远处失败概率，并在CRCT前提高局部缓解率。
