TEP方案治疗小细胞肺癌的临床研究

Clinical study of TEP regimen in the treatment of small cell lung cancer

目的 :探讨拓扑替康 (topotecan ,TPT )联合依托泊苷 (etoposide ,Vp -16)、顺铂 (cisplatin ,DDP)组成的TEP方案治疗小细胞肺癌的临床疗效、生存期和耐受性。方法 :45例初治SCLC患者 ,其中TEP方案治疗组 2 1例 ,EP方案对照组 2 4例。结果 :TEP组CR 8例 ,PR 8例 ,有效率 (RR)为 76.2 % ,局限期 (LD)者RR为 90 .0 % ,广泛期 (ED)者RR为 63 .6% ,其中 4例脑转移者PR 1例。EP组中CR 7例 ,PR 9例 ,RR为 66.7% ,LD者RR为 81.8% ,ED者RR为 53 .8% ,其中 5例脑转移者未见CR、PR者。两组有效率比较无显著性差异 (P >0 .0 5)。TEP组中位生存期 11.5个月 ,一、二年生存率分别为 42 .9%和 19.0 % ;EP组中位生存期 8.5个月 ,一、二年生存率分别为3 7.5%和 8.3 % ,两组生存期比较 ,差异具有显著性 (P <0 .0 5)。两组主要不良反应为骨髓抑制 ,TEP组Ⅲ～Ⅳ度白细胞减少的发生率 76.2 % (16/ 2 1)明显高于EP组 3 7.5% (9/ 2 4) ,具有统计学意义 (P <0 .0 5) ;两组血小板减少的发生率分别为 61.9%和 3 3 .3 % ,差异显著 (P <0 .0 5)。结论 :TEP方案治疗SCLC疗效肯定 ,可能具有治疗和预防脑转移的作用 ,其生存期及生存率较EP方案均有改善 ,可作为SCLC的一线治疗应用 ;主要不良反应为骨髓抑制 。

Purpose:To evaluate the effects,the survival t ime and the adverse effects of TEP(topotecan+etoposide+cisplatin) regimen as com pared to EP regimen in the treatment of small cell lung cancer.Methods :A total of 45 previously untreated small-cell lung cancer (SCLC) patien ts were included. 21 patients received TEP regimen and 24 patients received EP r egimen. The characteristics of the patients were comparable according to statist ical test.Results:The overall response rate was 76.2% for TEP g roup with 8 complete response(CR)and 8 partial response (PR), and 66.7% in the EP group with 7 CR and 9 PR. The response rate of limited stage and extensive s tage were 90.0% and 63.6% for TEP group and 81.8% and 53.8% for EP group , respe ctively (P>0.05). The median duration of survival was 11.5 months for TEP gr oup versus 8.5 months for EP group (P<0.05, with statistical difference). Th e 1,2-year survival rates were 42 9% and 19.0% in the TEP group ,and 37.5% and 8.3%in the EP group(P>0.05,no statistical difference). The main toxicity wa s myelosuppression for the two groups.The incidence rate of Ⅲ～Ⅳ degree neutro p enia and thrombocytopenia was higher in the TEP group than that in the EP group( P<0.05, with statistical difference).Conclusions:TEP regime n is an effective regimen for treatment of previously untreated SCLC, and the re gimen is possibly effective in prevention and treatment of brain metastasis in S CLC patients. The duration of survival and survival rate has been improved in th e TEP group .The major toxicity is myelosuppression.