局限期小细胞肺癌化疗及联合放化疗的远期疗效观察

目的　观察单纯化疗及放射治疗联合化疗对局限期小细胞肺癌的疗效以及不同放射治疗剂量对疗效的影响。方法　回顾性分析黑龙江省肿瘤医院 1988年 2月至 1998年 3月收治的经病理证实的局限期小细胞肺癌 12 8例 ,单纯化疗 42例 ,同步放化疗 3 8例 ,交替放化疗 48例。放疗总剂量≤ 45Gy 2 0例 ,≥60Gy2 3例 ,>45Gy且 <60Gy 43例。 结果　同步治疗组、交替治疗组和单纯化疗组的 3年生存率分别为2 3 .7%、2 0 .8%和 4.8% ,同步治疗组和交替治疗组分别与单纯化疗组比较 ,差异均有显著性 (P <0 .0 5 ,P <0 .0 5 ) ,同步治疗组与交替治疗组之间 ,无显著性差异 (P >0 .0 5 )。胸部照射≤ 45Gy和≥ 60Gy剂量组的 2年局部复发率分别为 5 5 .0 %和 8.7% ,有显著性差异 (P <0 .0 1)。结论　化疗联合放射治疗能提高局限期小细胞肺癌患者的生存期。局部复发率与胸部照射剂量有密切关系。     

同步放化疗与单纯化疗治疗局限期小细胞肺癌疗效分析

目的　评价同步放化疗对局限期小细胞肺癌的近期疗效。方法　 42例局限期小细胞肺癌患者被随机分为两组 :同步放化疗组选用CAP/EP交替方案化疗 ,单数周期用CAP方案 ,CTX 5 0 0mg/m2 ,d1、8,ADM 5 0mg/m2 ,d1,DDP 60mg/m2 ,d1、8,配合止吐药及水化。双数周用EP方案 ,VP 1610 0mg/m2 ,d1～ 5,DDP 60mg/m2 ,配合止吐药及水化 ,2 1天为一周期 ;第 15天开始直线加速器放疗 2Gy/次 ,DT 40Gy/4周后缩野避开脊髓DT 2 0Gy/2周。并行颅脑预防照射DT 3 0Gy/3周。单纯化疗组化疗方案同同步放化疗组。结果　同步放化疗组和单纯化疗组的完全缓解率分别是 40 %和 2 5 % ,经统计学处理有显著性差异 (P <0 0 5 ) ,两组的有效率分别是91%和 85 % ,经统计学处理无显著性差异 (P >0 0 5 )。结论　同步放化疗对局限期小细胞肺癌具有较好的疗效 ,使其完全缓解率有了较大提高     

局限期小细胞肺癌的放化疗

肺癌是引起肿瘤相关死亡的首要原因之一,其中15%～20%的患者为小细胞肺癌。小细胞肺癌的恶性程度高,易于远处转移,常至骨、肝、脑及肾上腺,并迅速导致患者死亡。目前大约25%～30%的小细胞肺癌患者确诊时尚为局限期,行放疗及化疗的联合治疗是目前此类患者的标准治疗措施。通常所选择的化疗方案为EP或EC,共4个周期,放疗常采取1f/d的胸部放射治疗,范围包括病变区及纵膈,总剂量在50～60Gy之间,并需要早期同步参与化疗。为提高放疗的生物学效应,关于超分割放疗的临床试验正进一步被评价。本文简要的阐述了局限期小细胞肺癌的治疗策略,也会进一步探讨放化疗时序的重要性。     

局限期小细胞肺癌的放射治疗

小细胞肺癌 (ｓｍａｌｌｃｅｌｌｌｕｎｇｃａｎｃｅｒ,ＳＣＬＣ)约占原发性肺癌的 2 0 %。临床上一般将ＳＣＬＣ简单地分为局限期小细胞肺癌 (ｌｉｍｉｔｅｄｓｔａｇｅｓｍａｌｌｃｅｌｌｌｕｎｇｃａｎｃｅｒ,ＬＳＣＬＣ)和广泛期小细胞肺癌 (ｅｘｔｅｎｓｉｖｅｓｔａｇｅｓｍａｌｌｃｅｌｌｌｕｎｇｃａｎｃｅｒ,ＥＳＣＬＣ)。ＥＳＣＬＣ的病变范围超出一侧胸腔 ,治疗以化疗为主辅以姑息性放射治疗。ＬＳＣＬＣ的病灶范围较为局限 ,在全身化疗消灭远处微小转移灶的基础之上联合局部放射治疗 ,有可能使部分患者得到长期生存 ,ＬＳＣＬＣ…     

综合外科手术治疗局限期小细胞肺癌51例临床分析

背景与目的:小细胞肺癌由于生长迅速,确诊时常已出现远处转移,而化疗成为其主要的治疗方法,但单纯化疗常因原发灶或纵隔淋巴结复发而导致治疗失败。本研究探讨综合外科手术治疗局限期小细胞肺癌能否有效地控制原发灶并提高其疗效。方法:回顾分析我院1981年5月至2001年5月接受手术治疗的51例局限期小细胞肺癌患者的临床资料。结果:按照1997年国际肺癌分期标准,Ⅰb期7例(占13.7%),Ⅱa期5例(9.8%),Ⅱb期15例(29.4%),Ⅲa期20例(39.2%),Ⅲb期4例(7.8%)。全肺切除12例,肺叶切除35例,楔形切除3例,探查术1例。13例单纯手术治疗,38例结合2～6疗程的术前或术后化疗。全组中位生存期为20.8个月,1、3、5年生存率分别为43.0%、25.9%和20.1%。Ⅰb期患者1、3、5年生存率分别为100.0%、80.0%和30.0%;Ⅱ期患者1、3、5年生存率分别为79.7%、39.8%和34.5%;Ⅲ期患者1、3、5年生存率分别为52.4%、21.8%和5.46%。手术结合化疗组1、3、5年生存率分别77.5%、38.5%和23.8%;单纯手术组1、3、5年生存率分别为41.7%、16.7%和8.3%,两组比较差异有显著性(P<0.01)。结论:综合外科手术治疗能提高局限期小细胞肺癌的生存率,可作为临床选用的治疗方法之一。     

局限期小细胞肺癌放射治疗研究进展

摘 要：手术、全身化疗、胸部放疗及预防性脑照射的综合治疗已成为局限期小细胞肺癌的治疗共识。近几十年,药物治疗没有明显突破。在放射治疗方面,放射治疗加入的时机、靶区范围、剂量分割方式以及预防性脑照射等是研究热点问题。全文对局限期小细胞肺癌放疗方面的相关争议及研究进展作一分析。     

局限期小细胞肺癌的放射治疗

小细胞肺癌（small cell lungcancer,SCLC）目前约占肺癌的15％,多认为SCLC起源于支气管上皮和黏液腺中的Kulchistky细胞,趋向于神经内分泌的分化功能,常能引起异常的内分泌综合征如异常抗利尿综合征,类癌综合征,柯兴氏综合征等。以男性吸烟者关系密切,大多为中心型,病情进展迅速,恶性程度极高,常侵犯周围组织,中枢神经系统的转移和复发较常见,对放化治疗敏感。     

局限期小细胞肺癌序贯治疗的相关预后因素分析

目的 探讨新辅助化疗+手术切除+辅助化疗序贯治疗局限期小细胞肺癌(SCLC)的疗效,并对患者远期预后的影响因素进行分析.方法 收集33例接受新辅助化疗+肺癌根治性切除术+辅助化疗序贯治疗的局限期SCLC患者的病历资料.分析局限期SCLC患者的预后情况,采用Cox比例风险模型分析局限期SCLC患者预后的影响因素.结果 3...     

局限期小细胞肺癌放射治疗的相关研究

肺癌的发生率和死亡率占城市恶性肿瘤之首位,其中小细胞肺癌（small cell lung cancer,SCLC）约占15％-20％,其生物学行为及临床特点与其他类型肺癌不同,主要表现为癌细胞倍增时间短、侵袭性强、分化程度低、较早出现远处转移、预后较差,但对放疗及化疗均很敏感,而近30年来的研究表明：SCLC是所有治疗敏感的肿瘤中最难治愈的一种。     

应用倾向评分匹配法评价ⅢA-N2期非小细胞肺癌术后放疗的价值

 目的 分析ⅢA-N2期非小细胞肺癌根治术后辅助放疗（postoperative radiotherapy, PORT）的作用。方法 收集313例非小细胞肺癌根治术后化疗后的ⅢA-N2期患者的临床资料,对PORT（+）组及PORT（-）组资料应用倾向评分匹配方法均衡组间协变量差异,观察两组生存及局控,分析术后放疗的作用及获益人群。结果 匹配后两组患者中,PORT（+）组与PORT（-）组3、5年生存率分别为76.5%、58.3%和52.1%、40.6%（P=0.162）;3、5年局部控制率分别为82.9%、73.7%和56.5%、42.4%（P=0.036）;3、5年无进展生存率分别为74.8%、65.5%和39.5%、29.6%（P=0.021）。分层分析发现术后放疗可降低隆突下淋巴结转移、肿瘤最大径≥3cm、多站转移、非跳跃转移及术前N2亚组的局部复发风险。结论 术后放疗可提高ⅢA-N2期非小细胞肺癌术后化疗后局部控制率及无进展生存率;亚组分析中隆突下淋巴结转移、肿瘤最大径≥3 cm、多站转移、非跳跃转移及术前N2者获益较大。     

局限期小细胞肺癌放化疗综合治疗

[目的]研究常规放疗及加速超分割放疗联合化疗治疗局限期小细胞肺癌的近期疗效及生存期.[方法]1998年2月至2000年5月间,局限期小细胞肺癌共72例随机分为2组,常规放疗组34例和加速超分割放疗组38例.两组接受EP方案化疗2个疗程后开始放疗.常规放疗组2Gy/次,每天1次,每周5次,总量(56～60)Gv/(5.6～6)w.加速超分割组放疗1.4Gy/次,每日2次,2次间隔≥6小时,每周5日,总量56Gy/4w.放射野包括原发灶,同侧肺门、纵隔淋巴引流区.2组病人在完成放疗后继续EP方案化疗4个疗程.[结果]全组总有效率77.8%,中位生存期18个月,常规放疗组和加速超分割放疗组两组近期疗效分别为70.6%和84.2%(P＞0.05),两组1、2、3年生存率分别为76.5%、23.3%、10.9%和80.0%、32.6%、11.7%(P＞0.05).[结论]加速超分割放疗组的近期疗效及长期生存率等同于常规分割放疗组.     

Survival Following Surgery with or without Adjuvant Chemotherapy for Stage I–IIIA Non‐Small Cell Lung Cancer: An East Asian Population‐Based Study

Background.

Asian ethnicity is associated with a distinct molecular etiology, treatment response, and survival outcome among patients with non-small cell lung cancer (NSCLC). This study examines the survival impact of platinum-based adjuvant chemotherapy for Asian patients with stage I–IIIA NSCLC.

Methods.

This study recruited patients aged ≥18 years with histologically proven stage IA–IIIA NSCLC registered in the Taiwan Cancer Registry database in January 2004 to December 2007. Platinum-containing adjuvant chemotherapy had to be started within 90 days of the primary surgery. Kaplan–Meier survival curves, log-rank tests, and the Cox proportional hazards regression model were used to assess the influence of various risk factors on survival time.

Results.

This study included 2,231 patients with stage IA–IIIA NSCLC who underwent primary surgery with a clear surgical margin. The percentages of all causes of death were significantly lower for the chemotherapy group for both stage II and stage IIIA patients. Multivariate analysis identified platinum-based adjuvant chemotherapy as an independent prognostic factor for the overall survival outcome of stage II (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.39–0.94; p = .024) and IIIA (HR, 0.71; 95% CI, 0.52–0.96; p = .029) patients. Among these patients, those who received adjuvant chemotherapy had a superior overall survival outcome for both genders, for the subgroup of patients aged ≥70 years, and for those with adenocarcinoma.

Conclusion.

Platinum-based adjuvant chemotherapy should be considered in the treatment plan for Asian patients with resected stage II and stage IIIA NSCLC.     

The Rationale for Adjuvant Chemotherapy in Stage I Non-small Cell Lung Cancer

The past decade has witnessed renewed interest in studies exploring the benefits of adjuvant (postoperative) chemotherapy (± radiation therapy) in patients with resected non-small cell lung cancer (NSCLC). Recently completed adjuvant trials have included a heterogeneous group of patients with resected stages I to IIIA NSCLC. With rare exception, the published results of these studies indicate adjuvant chemotherapy imparts a significant overall survival advantage. Subset analyses suggest survival benefit occurs primarily in patients with resected stage II or IIIA and is less likely to occur in stage I patients. This apparent lack of survival benefit in stage I patients was seemingly validated in a prospective trial conducted by the Cancer and Leukemia Group B in which stage IB patients were randomized to observation or adjuvant carboplatin and paclitaxel. Survival at 5 -years was identical in the two arms of this trial. By contrast, two contemporary postoperative chemotherapy trials also conducted exclusively in stage I NSCLC patients yielded positive survival results. The divergent outcome of the prospective trials along with the negative subset analyses has created uncertainty as to the utility of postoperative adjuvant chemotherapy in stage I NSCLC. Herein we review the data underlying this controversy and offer a proposed algorithm to aid the clinician in selecting patients whom we believe may benefit from adjuvant chemotherapy. The treatment algorithm is based on currently available tumor- and host-related factors that affect prognosis.     

非小细胞肺癌术后辅助化疗和靶向治疗的临床疗效对比分析

目的 比较观察术后辅助化疗和易瑞沙用于Ⅲa期非小细胞肺癌(NSCLC)的术后辅助治疗的疗效.方法 入组76例Ⅲa期行完全性切除术的NSCLC,选择口服易瑞沙治疗33例,选择术后辅助化疗43例.治疗结束后分别观察两组的生存情况.结果 易瑞沙组1、2年生存率分别为93.9%和51.5%,化疗组分别为88.4%和48.8%,...     

Adjuvant Therapy in Non‐Small Cell Lung Cancer: Current and Future Directions

The cornerstone of treatment for early‐stage non‐small cell lung cancer (NSCLC) has long been surgical resection. Over the past few years, there has been a paradigm shift to provide adjuvant platinum‐based chemotherapy for patients with completely resected stage II–IIIA NSCLC founded on large randomized clinical trials demonstrating longer overall survival with this treatment. Reassuringly, the National Cancer Institute of Canada Cancer Therapeutics Group JBR.10 trial recently reported a continued survival advantage for patients treated with adjuvant chemotherapy after >9 years of median follow‐up. In contrast, the gains from using this approach for stage IB disease are less clear, although data from an unplanned subgroup analysis suggest benefit for patients with tumors ≥4 cm. Herein, we review the evidence supporting adjuvant therapy in early‐stage NSCLC patients before discussing key mitigating factors in providing treatment, such as stage of disease and the impact of the new seventh edition of the tumor–node–metastasis classification system. Criteria such as patient age and performance status, as well as the value of appropriate chemotherapy selection, are highlighted as measures to help guide management. The role of postoperative radiotherapy and the future landscape of early‐stage NSCLC research are also explored; namely, therapeutic strategies exploiting pharmacogenomic and gene‐expression profiling, in an attempt to personalize care, and the integration of novel targeted therapies into adjuvant clinical trials.     

外科手术在治疗病变局限期小细胞肺癌中的地位

近年对外科手术在治疗局限期小细胞肺癌中的地位有了重新的认识。现有资料认为采用综合治疗力争根治性切除是使患者长期存活的重要治疗模式。化、放疗仍是小细胞肺癌的主要治疗手段 ,手术应掌握适应证。总的策略是在术前诱导化疗的基础上手术 ,辅以必须的术后化疗。手术能够完全切除的 ,术后应进行预防性颅脑照射。对于术中发现肺门和纵隔淋巴结转移的 ,建议术后纵隔放疗