Kamath S S, McCarley D L, Zlotecki R A
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA.
Radiat Oncol Investig. 1998;6(5):226-32. doi: 10.1002/(SICI)1520-6823(1998)6:5<226::AID-ROI4>3.0.CO;2-H.
In an attempt to verify the relative efficacy of early concurrent vs. sequential timing of thoracic radiotherapy (TRT) and platinum/etoposide chemotherapy, 48 patients with limited-stage small cell lung cancer treated with either early-concurrent (29 patients) or sequential (19 patients) TRT and platinum/etoposide chemotherapy were evaluated. Disease-specific prognostic variables and the role of prophylactic cranial irradiation (PCI) were also analyzed. Thirty-four patients (71%) received TRT to a dose of 45 Gy in 25 fractions (range, 30-55 Gy). Most patients (75%) received 4-6 cycles of chemotherapy. Twenty-one of 27 patients achieving a complete response after completion of TRT and chemotherapy received PCI. Median follow-up was 29.3 months (range, 12-98 months). Variables of potential prognostic significance were evaluated by both univariate and multivariate analysis. The absolute and relapse-free survival rates for all patients were 42% and 35% at 2 years and 32% and 31% at 5 years, respectively. Thirty-six sites of failure were observed in 27 patients. Thoracic recurrence occurred in nine patients, and the central nervous system (CNS) was the most common site of distant failure (15 patients). Multivariate analysis demonstrated that (a) early concurrent TRT and chemotherapy vs. chemotherapy followed by sequential TRT and (b) disease volume [less than or greater than one-third of the thoracic width] were significantly predictive for survival (P=0.036 and P=0.05, respectively). Rates of control of thoracic disease were 79% for patients with a disease volume less than one-third of the thoracic width vs. 36% for disease volumes greater than one-third of the thoracic width (P=0.0009). Early concurrent TRT and chemotherapy resulted in a significantly lower incidence of distant metastasis (26% for concurrent vs. 63% for sequential; P=0.008). In patients who received PCI, the CNS control rate was 86% vs. 56% in patients not treated with PCI. Our findings suggest that (a) treatment with early concurrent TRT and platinum/etoposide chemotherapy may improve survival when compared with sequential treatment and (b) PCI for patients with complete systemic responses is effective in preventing CNS recurrence. We also conclude that thoracic disease volume is a significant prognostic factor for both local control and overall survival.
为了验证早期同步与序贯进行胸部放疗（TRT）及铂类/依托泊苷化疗的相对疗效，我们评估了48例局限期小细胞肺癌患者，这些患者接受了早期同步（29例）或序贯（19例）TRT及铂类/依托泊苷化疗。还分析了疾病特异性预后变量及预防性颅脑照射（PCI）的作用。34例患者（71%）接受了25次分割、剂量为45 Gy的TRT（范围30 - 55 Gy）。大多数患者（75%）接受了4 - 6周期化疗。27例在TRT和化疗完成后达到完全缓解的患者中有21例接受了PCI。中位随访时间为29.3个月（范围12 - 98个月）。通过单因素和多因素分析评估了具有潜在预后意义的变量。所有患者2年时的绝对生存率和无复发生存率分别为42%和35%，5年时分别为32%和31%。27例患者共观察到36个失败部位。9例患者发生胸部复发，中枢神经系统（CNS）是远处失败最常见的部位（15例）。多因素分析表明，（a）早期同步TRT和化疗与序贯TRT及化疗相比，以及（b）疾病体积[小于或大于胸腔宽度的三分之一]对生存有显著预测作用（P分别为0.036和0.05）。疾病体积小于胸腔宽度三分之一的患者胸部疾病控制率为79%，而疾病体积大于胸腔宽度三分之一的患者为36%（P = 0.0009）。早期同步TRT和化疗导致远处转移发生率显著降低（同步治疗为26%，序贯治疗为63%；P = 0.008）。在接受PCI的患者中，CNS控制率为86%，未接受PCI治疗的患者为56%。我们的研究结果表明，（a）与序贯治疗相比，早期同步TRT和铂类/依托泊苷化疗可能改善生存，（b）对于全身反应完全的患者，PCI可有效预防CNS复发。我们还得出结论，胸腔疾病体积是局部控制和总生存的重要预后因素。
