同步放化疗加巩固化疗治疗Ⅲ期不能手术老年非小细胞肺癌的疗效观察

目的 观察同步放化疗加巩固化疗与序贯放化疗治疗Ⅲ期不能手术老年非小细胞肺癌(non-small cell carcinoma,NSCLC)的临床疗效.方法 临床纳入不能进行手术的老年NSCLC患者70例,根据治疗方案的不同分为研究组与对照组,研究组进行同步放化疗加巩固化疗,对照组进行序贯放化疗.观察:①治疗前后2组患者血清癌基因蛋白CD44v6、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平;②2组患者临床治疗有效率;③观察治疗期间2组患者不良反应发生情况.结果 ①治疗前,2组患者血清CD44v6、VEGF水平差异无统计学意义(P＞0.05);治疗后,研究组血清CD44v6、VEGF水平分别为(280.95±74.22) ng/L、(132.36±64.64) ng/L,对照组分别为(361.36±80.54) ng/L、(178.38±55.31) ng/L,差异有统计学意义(P＜0.05);②研究组治疗有效率为74.29％,对照组治疗有效率为51.43％,差异有统计学意义(P＜0.05);(2组患者Ⅲ～Ⅳ级不良反应发生率比较差异无统计学意义(P＞0.05).结论 同步放化疗加巩固化疗治疗Ⅲ期不能手术老年NSCLC的疗效优于序贯放化疗,值得推广.     

局部晚期非小细胞肺癌的同步放化疗

局部晚期非小细胞肺癌(NSCLC)非手术治疗的标准手段为同步放化疗.同步放化疗中常用的化疗方案有EP方案、NP方案、DC方案及PC方案.新药联合方案及靶向治疗目前仍处于研究阶段.老年患者的耐受性下降,但并非同步放化疗的绝对禁忌人群.超分割及高剂量放疗虽然耐受性尚可,但其有效性及远期不良反应仍需进一步研究和评估.     

同步放化疗与序贯放化疗治疗Ⅲ期不能手术非小细胞肺癌患者的疗效及不良反应

目的探讨同步放化疗与序贯放化疗治疗Ⅲ期不能手术非小细胞肺癌(NSCLC)的临床疗效和不良反应。方法选择2008年1月至2013年9月间收治的192例Ⅲ期不能手术的NSCLC患者。依据治疗方法,将患者分为同步放化疗组(同步组,144例)和序贯放化疗组(序贯组,48例)。其中,同步组又依据患者采用的放化疗方案分为同步1组(48例)、同步2组(48例)和同步3组(48例)。观察比较两组患者的临床疗效和不良反应。结果同步3组患者治疗总有效率为79.2%显著高于序贯组(66.7%,P<0.05);同步1组和同步2组患者4级放射性食管炎、放射性肺炎、骨髓抑制发生率均显著高于同步3组(P<0.05)。结论与序贯放化疗比较,同步放化疗结合适形放疗治疗Ⅲ期不能手术的NSCLC,更能有效地提高总有效率,同时降低不良反应发生率。     

生物免疫疗法联合放化疗治疗局限性非小细胞肺癌的疗效及对生活质量的影响

目的 探讨生物免疫疗法联合放化疗治疗局限性非小细胞肺癌(NSCLC)患者的临床效果.方法 将82例局限性NSCLC患者按简单随机化方法分为联合组(41例)与对照组(41例).对照组行常规放化疗治疗,联合组联合使用生物免疫疗法治疗.连续治疗2个月后,比较两组患者临床疗效、生活质量、T淋巴细胞亚群[自然杀伤(NK)细胞、CD3+、CD4+/CD8+]与不良反应.结果 联合组患者治疗有效率、NK、CD3+、CD4+/CD8+、卡氏功能状态(KPS)评分均高于对照组,差异均有统计学意义(P﹤0.05);联合组患者治疗期间粒细胞减少、发热和胃肠道反应发生率均低于对照组,差异均有统计学意义(P﹤0.05).结论 生物免疫疗法联合放化疗治疗局限性NSCLC可提高治疗效果,增强患者免疫功能,减轻不良反应,提升生活质量.     

辨证论治提高老年晚期非小细胞肺癌同步放化疗耐受性的临床观察

目的:采用国际生存质量量表评价中医辨证论治提高老年晚期非小细胞肺癌(NSCLC)同步放化疗的耐受性.方法:将20例III-IV期老年NSCLC患者随机分为两组,研究组(10例)接受中医辨证论治及同步放化疗,对照组(10例)仅进行同步放化疗,共观察两个疗程.采用EORTC QLQ-C30、KPS、ECOG作为测定工具.结果:研究组生存质量各领域评分治疗后改善明显,对照组则下降,两组间比较差异有显著性(P<0.05);KPS、ECOG评分显示相似结果.结论:老年晚期非小细胞肺癌同步放化疗配合中医辨证论治能够改善患者生存质量,改善体能状态.     

金龙胶囊联合同步放化疗治疗中晚期非小细胞肺癌临床观察

目的观察金龙胶囊联合同期放化疗对非小细胞肺癌(NSCLC)的近期疗效及毒副作用。方法 64例局部晚期NSCLC患者,随机分为金龙胶囊联合放化疗治疗组32例,单纯放化疗治疗32例为对照组,放射治疗采用常规放疗,剂量5600～6000 cGy,同步化疗采用吉西他滨+顺铂(GP)方案化疗4周期。对照组采用单纯放化疗,治疗组采用同步放化疗联合金龙胶囊治疗。结果放化疗结束1个月,金龙胶囊治疗组患者的CR率和有效率(PR+CR)分别为16.7%、61.1%;对照组患者的CR率和有效率(PR+CR)分别为13.9%、58.3%,近期疗效无差异,治疗组生活质量明显提高,骨髓抑制、放射性肺损伤及放射性食管炎等放化疗毒副反应降低。结论金龙胶囊联合GP方案同步化放疗治疗中晚期肺癌,减轻了放化疗所致的毒副反应,生活质量改善明显,提高了中晚期肺癌的放化疗耐受性,值得在临床上大力推广应用。     

老年非小细胞肺癌患者预后因素分析

目的探讨70岁以上不能手术的非小细胞肺癌(NSCLC)患者的预后因素。方法回顾性分析85例老年晚期NSCLC患者的临床资料,探讨性别、体能状态、分期、病理类型、有无合并症、治疗方式等6个因素对预后的影响。结果单因素分析显示,体能状态、分期、治疗方式与患者预后相关,性别、病理类型、有无合并症与预后无关。多因素分析结果显示,分期(P=0.013)和治疗方式(P=0.016)为影响预后的独立因素。结论不能手术的老年NSCLC患者的预后与临床分期、治疗方式有关,积极的放化疗较支持治疗能够延长患者的生存时间。     

吉西他滨联合顺铂方案治疗25例晚期非小细胞肺癌

非小细胞肺癌(NSCLC)由于早期发现较为困难,确诊后常常已经失去手术根治的机会,只能进行放化疗.吉西他滨(健择,gemcitabine)为一种新型抗代谢类肿瘤新药.本研究试用吉西他滨联合顺铂(cisplatin,DDP)方案(简称GP方案)治疗晚期NSCLC,以探讨其疗效及不良反应.材料和方法     

Cetuximab治疗非小细胞肺癌的进展

表皮生长因子受体(EGFR)在非小细胞肺癌(NSCLC)患者中存在过表达.Cetuxumab(C225,erbitux)是一种单克隆抗体,可竞争性结合EGFR细胞外配体区,抑制肿瘤生长,与放化疗有协同作用.本文综述cetuxumab联合放化疗治疗晚期NSCLC的临床前和临床资料,显示出cetuxumab具有良好耐受性.     

NP与NO方案治疗老年晚期非小细胞肺癌的对比观察

目的 比较长春瑞滨联合顺铂(NP)与长春瑞滨联合奥沙利铂(N0)方案治疗老年晚期非小细胞肺癌( NSCLC)的临床疗效和毒副反应.方法56例无法手术或术后复发转移的老年晚期NSCLC随机分为两组,分别给予NP和NO方案化疗,治疗2个周期后分别评价临床疗效和毒副反应.结果NP方案组总有效率为46.2%,NO方案组为50....     

Treatment of stage I-III non-small-cell lung cancer in the elderly

Elderly patients with stage I-III non-small-cell lung cancer (NSCLC) constitute a peculiar patient population and need specific therapeutic approaches. Limited resections are an attractive alternative for elderly patients with resectable NSCLC because of the potential reduction in postoperative complications. Curative radiation therapy is an acceptable alternative for elderly patients who are unfit for or refuse surgery. Hypofractionated stereotactic body radiation therapy is of particular interest for this population because of its favorable tolerance. Elderly patients may tolerate chemotherapy poorly because of comorbidity and organ failure. The survival benefit obtained with adjuvant platinum-based chemotherapy in the younger population may vanish or decrease in the elderly because of a potential higher toxic death rate or lower compliance to treatment. The efficacy and feasibility of adjuvant chemotherapy for elderly patients need to be investigated in specific trials. Neoadjuvant chemotherapy remains an experimental approach under investigation in the general patient population, and consequently should not be considered in clinical practice in the elderly. Retrospective analyses on chemoradiation in elderly patients should be considered globally ambiguous and at risk of selection bias. Only specifically designed prospective studies will elucidate the real role and feasibility of this combined approach in the treatment of unselected elderly patients.     

The Addition of Chemotherapy to Radiation Therapy Improves Survival in Elderly Patients with Stage III Non–Small Cell Lung Cancer

Introduction

Elderly patients account for the majority of lung cancer diagnoses but are poorly represented in clinical trials. We evaluated the overall survival (OS) of elderly patients with stage III NSCLC treated with definitive radiation compared with that of patients treated with definitive chemoradiation.

Results of Trimodality Therapy in Patients With Stage IIIA (N2-Bulky) and Stage IIIB Non–Small-Cell Lung Cancer

BackgroundThe survival rates for stage IIIA and stage IIIB Non–Small-cell lung cancer (NSCLC) are extremely poor with single-treatment modalities such as radiation therapy or surgery. The purpose of this study is to assess tolerability, response, surgical resectability, and survival of chemotherapy followed by chemoradiation therapy, and then followed by surgery in patients with stage IIIA (N2-bulky) or stage IIIB NSCLC.Patients and MethodsForty-eight patients with stage IIIA (N2-bulky) or stage IIIB (T4 N1-2 M0) NSCLC received 2 cycles of chemotherapy with cisplatin, mitomycin, and vindesine, subsequent radiation therapy (45 Gy, twice-daily 1.5 Gy) with simultaneous low-dose cisplatin and vindesine, followed by surgery.ResultsForty-five patients completed induction chemoradiation therapy. Thirty-three patients (68.8%) had clinical response to induction treatment. Thirty-nine patients underwent a thoracotomy, with a complete resection rate of 62.5% (30/48). The pathologic response rate was 60% (27/45), with complete pathologic response of 8 patients. The median survival time for the total group of 48 patients was 23 months, with 3- and 5-year survival rates of 41.7% and 31.8%, respectively. Multivariate analysis showed that complete resection and pathologic response in surgical specimens were independent predictors of survival (P = .048 and P = .022).ConclusionPreoperative sequence of chemotherapy followed by concurrent chemoradiation therapy is an effective approach in patients with stage IIIA (N2-bulky) and IIIB (T4 N1-2 M0) NSCLC. The operation after induction chemoradiation therapy should be performed in carefully selected patients with surgically resectable diseases. The patients who achieved complete resection and with pathologic response of tumor can benefit from surgery following induction chemoradiation therapy.     

Overview of chemoradiation clinical trials for locally advanced non-small cell lung cancer in Japan

The standard of care for unresectable stage III non-small cell lung cancer (NSCLC) is combined-modality therapy with both chemotherapy and thoracic radiation therapy (TRT). A phase III trial by the West Japan Lung Cancer Group revealed that the combination of mitomycin, vindesine, and cisplatin (MVP) with concurrent TRT yielded a median survival time of 16.6 months and a 5-year survival rate of 16% in patients with unresectable stage III NSCLC. Although evidence indicates that concurrent chemotherapy and TRT (chemoradiation) increases survival to a moderately greater extent than sequential therapeutic approaches, the optimal strategies for such concurrent treatment remain to be defined, and differ between full-dose systemic and low-dose radio-enhancing protocols. Two phase III trials have been initiated in Japan to address these issues and they have recently reported preliminary data. Early results of the Okayama Lung Cancer Study Group (OLCSG) trial, comparing chemoradiation based on divided docetaxel and cisplatin chemotherapy with MVP-based chemoradiation, have been reported. The West Japan Oncology Group (WJOG) is comparing the efficacy and toxicity of TRT and concurrent chemotherapy with either carboplatin-paclitaxel or carboplatin-irinotecan, followed by full-dose consolidation chemotherapy, with the efficacy and toxicity of MVP-based chemoradiation. Several phase I/II studies to test the optimal use of new agents such as S-1 (an oral anticancer drug combining tegafur, 5-chloro-2, 4-dihydroxypyridine, and potassium oxonate) and gefitinib (an inhibitor of the tyrosine kinase activity of the epidermal growth factor receptor) are also ongoing. In addition, radiation dose intensification with three-dimensional planning approaches is currently under evaluation. A phase I clinical trial by WJOG to establish, prospectively, the maximum tolerated dose of three-dimensional hyperfractionated radiotherapy with concurrent weekly chemotherapy (carboplatin-paclitaxel) is thus currently under way. This overview of ongoing trials highlights new directions in the treatment of locally advanced NSCLC.     

贝伐珠单抗在非小细胞肺癌中应用的研究现状

目前非小细胞肺癌化疗疗效已经达平台期,亟需寻找新的方法提高疗效。贝伐珠单抗是一种重组抗VEGF单克隆抗体,是首个证实与化疗联合可提高晚期NSCLC 患者生存的靶向治疗药物。近年来许多关于贝伐珠单抗在NSCLC 一线、二线、辅助、新辅助治疗、联合放化疗,安全性及预测标志物的临床研究,现将其研究现状做一综述。      

State-of-the-art chemotherapy for advanced non-small cell lung cancer

The treatment of advanced non-small cell lung cancer (NSCLC) has continued to evolve over recent years. We have moved from an era of therapeutic nihilism to optimism, largely because of the advent of the newer cytotoxic agents developed in the 1990s that have complemented the platinum compounds for treatment of advanced NSCLC. Doublet chemotherapy combinations have become the current standard of care for patients with advanced NSCLC who have a good performance status. For patients with poor performance status and the elderly, single-agent chemotherapy results in modest improvements in survival. Prolongation of survival and improved quality of life have also been shown with second-line chemotherapy for patients who are either refractory to or relapse following first-line chemotherapy. Noncytotoxic, molecularly targeted agents currently under various phases of development for the treatment of lung cancer will serve as the cornerstones for further innovations in the treatment of NSCLC.     

Induction Immunotherapy Followed by Thoracic Radiation without Chemotherapy in Unresectable Stage III Non-Small Cell Lung Cancer: A Case Series

Objective: Although concurrent chemoradiation has been the standard of care for unresectable stage III non-small cell lung cancer (NSCLC) due to increased survival and decreased disease progression, patients with poor performance status cannot tolerate chemotherapy toxicity well. Durvalumab, an immune checkpoint inhibitor targeting the programmed death receptor-1 (PD-1) / programmed death-ligand 1 (PD-L1) axis, demonstrated efficacy as maintenance therapy after definitive chemoradiation. However, the role of immunotherapy in those who cannot tolerate chemoradiation is unclear.Methods: This retrospective case series reports adult patients with PD-L1-expressing stage III NSCLC diagnosed at Parkview Cancer Institute from 2019-2021 and treated initially with pembrolizumab followed by sequential consolidation chest radiation (CXRT) without cytotoxic chemotherapy. Results: Four cases of stage IIIA squamous cell carcinoma were disease-controlled by this approach, with two partial and one complete response. One case of stage IIIC adenocarcinoma had progressive disease with brain metastasis prior to CXRT. Conclusion: This case series suggests that pembrolizumab with sequential CXRT may be beneficial for stage III NSCLC patients with high PD-L1 expression, but additional studies are needed to confirm this hypothesis.     

Weekly regimen of paclitaxel and carboplatin as first-line chemotherapy in elderly patients with stage IIIB-IV non small cell lung cancer (NSCLC): results of a phase II study

Single-agent chemotherapy is the preferred treatment option in chemonaive elderly patients with advanced nonsmall-cell lung cancer (NSCLC). The role of combination chemotherapy in this setting is uncertain although several studies report satisfactory efficacy and safety using weekly paclitaxel and carboplatin (AUC=6) as first-line chemotherapy in elderly patients. It is still unclear which schedule of this regimen which could offer the best therapeutic index. The aim of this study was to evaluate the activity and tolerability of concomitant weekly administration of paclitaxel and carboplatin in untreated elderly patients with advanced NSCLC. From february 2005 to April 2008 36 consecutive elderly patients with advanced NSCLC were enrolled. Median age was 74 years (range, 70-83 years) and median ECOG PS was 1 (range, 0-1). patients received carboplatin (AUC=2) and paclitaxel 80 mg/m2 on days 1,8 and 15 every 28 days. All patients were evaluable for efficacy and toxicity; a median of 4 cycles was administered. Twelve patients had partial response (33%; 95% C.I. 15,8-52,3%), 10 patients (28%) showed stable disease. The median time to progression (TTP) was 5.7 months (95% C.I. 3.1-8.6 months) with a median overall survival (MOS) of 9 months (95% C.I. 4.4-13.9 months). Toxicity was mild with no cases of febrile neutropenia; 5 patients (14%) developed grade 2 neuropathy. Our study confirms the substantial activity of weekly regimen of paclitaxel and carboplatin. Due to its favorable profile of toxicity this schedule could represent an interesting therapeutic option in selected chemonaive elderly patients with advanced NSCLC.     

老年晚期非小细胞肺癌一线含铂两药化疗方案的疗效与安全性分析

目的评价老年晚期非小细胞肺癌一线含铂两药化疗方案的疗效和安全性。方法对2007年1月至2009年12月在中国医学科学院肿瘤医院一线接受含铂两药方案化疗的73例老年晚期非小细胞肺癌(NSCLC)患者的临床治疗情况进行回顾性分析。结果 73例老年晚期NSCLC患者,化疗方案含紫杉醇、吉西他滨、长春瑞滨和培美曲塞的患者分别为47例、21例、3例和2例;含顺铂或卡铂者分别为27例和46例。疗效评价完全缓解(CR)0例,部分缓解(PR)31例(42.5%),稳定(SD)28例(38.4%),进展(PD)14例(19.2%),疾病控制率为80.9%。化疗方案中,含顺铂或卡铂以及含紫杉醇或吉西他滨对客观有效率和疾病控制率的影响差异无统计学意义(P>0.05)。13例(17.8%)患者未出现明显的不良反应,32例(43.8%)出现1/2级的血液学或非血液学毒性,24例(32.9%)出现3/4级血液学毒性,4例(5.5%)出现3/4级非血液学毒性。在评价为PR或SD的59例患者中,中位化疗周期数为4个周期,有43例(72.9%)患者完成了≥4个周期的含铂两药方案化疗。中位无进展生存时间为6.8个月。结论三代化疗药物的含铂两药化疗方案对一般状态好的老年晚期非小细胞肺癌患者有较好的疗效和耐受性,可以作为其一线化疗的治疗选择。     

Chemotherapy for non-small-cell lung cancer. Part 2: Advanced disease

The prognosis of patients with advanced non-small-cell lung cancer (NSCLC) remains poor. Systemic chemotherapy prolongs survival in this group of patients and palliates symptoms compared to best supportive care alone but more effective therapeutic strategies are needed. Novel agents that selectively target biological pathways of tumor growth offer hope of improving response and survival rates beyond what has been achieved with standard cytotoxic chemotherapy. Part 2 of this two-part article addresses the role of chemotherapy in locally advanced and advanced NSCLC, including the use of novel agents, considerations in elderly patients, and studies of second-line treatment.