足叶乙甙联合铂类一线化疗后复发的小细胞肺癌二线化疗的临床研究

目的：本研究旨在分析敏感性复发及难治性复发的小细胞肺癌的二线化疗效果。方法：2003年1月-2006年3月经足叶乙甙联合铂类一线化疗后复发的小细胞肺癌（SCLC）共64例，其中敏感性患者复发31例，难治性患者复发33例。对难治性复发或敏感性复发时间少于6月者，采用紫杉类或伊立替康单药化疗；对敏感性复发时间大于6月者仍采用原一线方案或更改为紫杉类或伊立替康单药化疗。结果：64例患者进行了二线化疗，有57例患者可评价疗效，二线治疗总有效率22．8％，中位疾病进展时间（mTTP）15．1周，中位生存期（MST）7．2月。敏感性复发组及难治性复发组的有效率（CR＋PR）分别为37．9％和7．1％（P〈0．01），mTTP分别为15．9周和10．4周（P〈0．05），MST分别为9．0月和6．0月（P〈0．05）。骨髓抑制为二线化疗的主要不良反应，敏感性复发组及难治性复发组G3／4级白细胞减少发生率分别为41．9％和42．4％，G3／4级血小板减少发生率分别为22．6％和30．3％，两组不良反应无明显差异（P〉0．05）。结论：足叶乙甙联合铂类一线化疗后复发的小细胞肺癌采用二线化疗有部分病例仍有效，特别是对于敏感性复发的患者。

Second-line chemotherapy in sensitive or refractory small cell lung cancer after primary treatment with platinum and etoposide

Objective:Despite a dramatic initial response to chemotherapy, most SCLC patients recurrent and the treatment is difficult. The aim of this study is to investigate the benefit of second-line chemotherapy in sensitive or refractory small cell lung cancer after primary treatment with platinum and etoposide.Methods:Between January 2003 and March 2006, 64 patients were treated with second-line chemotherapy :31 patients with sensitive (S) disease (recurred>3 months after first-line chemotherapy) and 33 patients with refractory (R) disease (recurred<3 months after first-line chemotherapy). Patients with R disease or S disease but failed<6 months after first-line chemotheraty received paclitaxel or docetaxel or irinotecan, patients with S disease and failed>6 months after first-line chemotheraty were re-treated with the same regimen or not.Results:All patients had received prior platinum-based therapy involving etoposide and either cisplatin or carboplatin, 57 patients were evaluated. The response rate to second-line chemotherapy was 37.9% in S group, 7.1% in R group, and 22.8% for the whole group. The media time to progression (TTP) was 15.9 weeks in S group, 13.9 weeks in R group, and 15.1 weeks for all patients. After a minimum potential follow-up of 15 months for all patients, the media survival was 9.0 months in S group, 6.0 months in R group, and 7.2 months for all patients. Myelosuppression was the most commonly observed adverse effect, Grade 3/4 neutropenia and thrombocytopenia were 41.9% and 22.6% in S group, 42.4% and 30.3% in R group. There was not significant difference of side effect between S and R!group.Conclusion:Second-line chemotherapy for replased SCLC patients after platinum compound etoposide is clinically effective. It is especially suitable for patients with sensitive relapsed SCLC.