顺铂联合依托泊苷或伊立替康及拓扑替康一线治疗小细胞肺癌的比较研究

Cisplation combined with etoposide irinotecan and topotecan respectively forpatients with small cell lung cancer as first-line treatment

目的:比较依托泊苷(Vp-16)、伊立替康(CPT-11)和拓扑替康(TPT)分别联合顺铂(DDP)组成的EP、IP和TP方案一线治疗小细胞肺癌(SCLC)的近期疗效及毒副作用。方法:81例SCLC患者采用随机数字表法分为3组,每组27例,分别接受EP、IP或TP方案化疗>3个周期,评价疗效和毒副作用。结果:EP组患者近期有效率(RR)为66.67%(18/27),IP组为74.07%(20/27),TP组为62.96%(17/27)。EP和IP组比较差异无统计学意义,χ2=0.089,P=0.766;EP和TP组比较差异无统计学意义,χ2=0.000,P=1.000;IP和TP组比较差异无统计学意义,χ2=0.343,P=0.559。EP组疾病控制率(DCR)为88.89%(24/27),IP组为88.89%(24/27),TP组为85.19%(23/27),差异无统计学意义,χ2=0.000,P=1.000。TP组Ⅲ～Ⅳ度白细胞下降发生率明显高于IP组,χ2=5.494,P=0.018;TP组Ⅲ～Ⅳ度血小板下降发生率明显高于EP组,χ2=3.668,P=0.050;IP组Ⅲ～Ⅳ度迟发性腹泻发生率明显高于其他两组,χ2=4.688,P=0.023。结论:IP和TP方案一线治疗SCLC与EP方案疗效相当,IP方案有相对较高的迟发性腹泻发生,TP方案有较高的血液毒性,这些毒副作用通过对症处理可控制。

OBJECTIVE：To compare the efficacy and toxicity of etoposide plus cisplation （EP） regiment,irinotecan plus cisplation （IP） regiment and topotecan plus cisplation （TP） regiment in first-line treatment of small cell lung cancer （SCLC）. METHODS：Totally 81 patients of SCLC were divided equally by digital random table method,and treated with EP regiment,IP regiment and TP regiment. All patients were given more than three chemotherapy cycles. The therapeu- tic effect and toxicity were evaluated after the treatment. RESULTS： The overall response rates （RR） were 66.67 （18/27） ,74.07%（20/27） and 62.96% （17/27）. There were no significant differences among the three groups （EP vs IP, ;（2=0.089,P=0.766;EP vs TP,X^2=0.000,P=1.000;IP vs TP,;（2=0.343,P=0.559）. The disease control rates （DCR） were 88.89 % （24/27）,88.89 % （24/27） and 85.19% （23/27）. There were no significant differences for the three groups （X^2 = 0. 000, P= 1. 000）. Ⅲ-Ⅳ grade leucopenia for that of TP regimen was higher than IP regimen （X^2 = 5. 494, P = 0. 018）. Ⅲ-Ⅳ grade thrombocytopenia for TP regimen was higher than that of EP regimen （X^2 = 3. 668, P = 0. 050）.Ⅲ-Ⅳ grade tardily diarrhea for IP regimen was higher than that for the other two groups （X^2 = 4. 688,P= 0. 023）. CON- CLUSIONS.. IP regimen and TP regimen in the first-line treatment of SCLC have good clinical efficancy. IP regiment has higher diarrhea incidence and TP regiment has higher hematological toxicities, and these side effects are tolerable by symp- tomatic treatment.