化疗和放射治疗应用时机和顺序与肺癌疗效(附94例局限期小细胞肺癌临床观察)

Time and sequence of chemotherapy and radiotherapy in the treatment of lung cancer:observation of 94 limited small cell lung cancer

目的 评价局限期小细胞肺癌应用化疗和放射治疗时机和顺序的重要性。方法 94例局限期小细胞肺癌按化疗和放射治疗使用的时间和顺序随机分为先化疗后放射治疗组( 简称序贯组,46 例) 和化疗、放射治疗交替组(简称交替组,48 例) 。化疗方案用顺铂(Cisplatin,PDD) + 依托泊甙(Etoposide,VP16)(EP方案) ,顺铂20 mg/m2 ,1～5 天,依托泊甙100 mg/m2 ,1 ～3 天,每3 ～4 周1疗程,共6 疗程。60Co 放射治疗:每次2 Gy,5 周,50 Gy;交替组在第1 个疗程化疗后第3 天开始,序贯组则在6 个疗程化疗结束后。结果 交替组完全缓解率高于序贯组(66 .7 % 对58.7% ),但差异无显著意义(P> 0.05) 。交替组2 年生存率高于序贯组(43.7 % 对23 .9 %) ,差异有显著意义( P<0 .05) 。结论 交替组疗效优于序贯组,提示尽早放射治疗可提高小细胞肺癌生存率;

Objective To assess the importance of the timing and sequencing of chemotherapy and radiotherapy in the combined chemoradiation therapy of locally limited small cell lung cancer.Methods Ninety four eligible patients with limited small cell lung cancer were randomly divided into two groups according to the timing and sequencing of chemotherapy and radiotherapy:(1) Sequential group:six courses of chemotherapy were given first and followed by a full course of radiation therapy in 46 cases. (2) Alternating group:radiation therapy started 3 days after the first cycle of chemotherapy in 48 cases; chemotherapy was given intermittently every 3 to 4 weeks as in conventional chemotherapy. Chemotherapy regimen:Cisplatin 20 mg/m 2 d l 5 and Etoposide 100 mg/m 2 d l 3. Locoregional radiotherapy consisted fo 50?Gy in 25 fractions over 5 weeks using cobalt 60. Results With a follow up of 24 months,66.7% had a complete response in the alternating group as compared with 58.7% in the sequential group (P>0.05). The 2 year survival rate was 43.7% in the alternating group as compared with 23.9% in the sequential group. There was a statistically significant difference (P<0.05).Conclusions These results suggest that early administration of locoregional radiotherapy may improve the survival.Alternating etoposide cisplatin chemotherapy and locoregional radiotherapy is the method of choice in the combined treatment for locally limited small cell lung cancer.