外周血干细胞支持合并大剂量化疗对12例小细胞肺癌的疗效

目的 探讨高剂量化疗用外周血干细胞支持提高小细胞肺癌的疗效、可行性、安全性.方法 小细胞肺癌首先采用常规化疗后取得病灶缩小者,动员外周血干细胞后用血细胞分离仪采取外周血干细胞后,再用高剂量化疗CVpP方案,化疗后24～48小时干细胞回输.观察白细胞变化,当白细胞＜1.5×109/L时进入层流室保护,直到白细胞＞1.5×109/L时出层流室,转普通病房.3周后胸片复查,达CR或PR者.有手术指征者予以切除,其中1例高剂量衡量后达PR,子手术切除,术后标本仅残留少量癌细胞,无手术指征者再进行放疗.结果 近期疗效有效率达100%(CR 27%,PR 73%),白细胞在第10～12天恢复正常,血小板在第13～14天恢复正常.主要不良反应为Ⅳ度骨髓抑制,仅1例有皮肤感染,未发生与治疗有关的死亡.结论 外周血干细胞支持合并高剂量化疗在肺癌治疗中有效、安全、可行.     

Pilot phase II study of hybrid chemotherapy of CAV-PVP in small cell lung cancer (SCLC)

A pilot phase II study of a hybrid chemotherapy for SCLC has been conducted between October 1986 and March 1988. Dose and schedule of the regimen were as follows: CTX, 700 mg/m2, on day 1; ADM 30 mg/m2, on day 1; VCR, 1.4 mg/m2, on day 1 (CAV); and CDDP, 60 mg/m2, on day 8; VP-16, 100 mg/m2, on days 8 and 9 (PVP). Courses were repeated q. 4 weeks up to 6 cycles. Patients with LD received chest irradiation at a dose of 50 Gy when maximal response was achieved. Thirty-six patients were fully evaluated for tumor response and toxicity. All 18 patients with LD responded to the regimen including 11 CRs (61%); there were 7 CRs (39%) and 9 PRs (50%) in patients with ED. Fourteen of the 18 patients with LD have survived for 7 to 22 months, against 12.8 months in ED patients. The major toxicity was myelosuppression, but it was well tolerated. These results indicate that hybrid chemotherapy is highly effective for SCLC, and warrants further clinical trials.     

放疗加GP方案化疗治疗中晚期非小细胞肺癌疗效观察

目的:观察放疗加GP方案化疗治疗中晚期非小细胞肺癌的疗效及毒副反应。方法:60例符合条件的患者随机分为两组。对照组(单放组):采用单纯放疗;观察组(放化组):采用放疗加GP方案化疗,放疗常规大野DT40Gy,后缩野到肿瘤区DT24Gy。化疗吉西他滨1200mg,ivd1、8,顺铂20mg,iv2次/周,共4周。治疗结束进行评价。结果:单放组总有效率80.00%,完全缓解率23.33%,放化组总有效率93.33%,完全缓解率53.33%。放化组完全缓解率显著高于单放组(P<0.05),总有效率两组无显著性差异(P>0.05)。毒副反应以消化道反应、骨髓抑制及放射性肺炎为主。放化组消化道反应及骨髓抑制发生率高于单放组,放射性肺炎发生率两组无差异。结论:放疗加GP方案化疗治疗中晚期非小细胞肺癌近期疗效优于单纯放疗。毒副反应有所增加,但病人可以耐受。     

First-line chemotherapy in metastatic small-cell lung cancer (SCLC)

The overall treatment results in metastatic small-cell lung cancer have not been changed in the last decades. The prognosis of the disease is still poor with median survival times of less than one year and nearly no chance of cure. This article intends to summarize the current status of treatment in m-SCLC and especially focuses on the aspects of choice of drugs and efforts of treatment intensification either by dose escalation or shortening of treatment intervals. Furthermore the currently available data about the activity of newer drugs, including taxanes and topoisomerase I inhibitors are reported. These cytostatic agents widen the therapeutic options in the treatment of SCLC and will hopefully improve the outcome of the patients in the next years.     

Mediastinal emphysema and small cell lung cancer (SCLC): a case-report

We present a case of a 59-year-old man with small cell lung cancer (SCLC) who developed heavy thoracic pain because of spontaneous mediastinal emphysema. Autopsy documented a mucosal lesion in the posterior tracheal wall with air leak towards the mediastinum. The occurrence of spontaneous mediastinal emphysema in patients with small cell lung cancer has rarely been described in the literature.     

Role of thoracic radiotherapy combined with chemotherapy in limited stage small cell lung cancer (SCLC). A randomized multicenter phase III trial

We initiated a prospective randomized multicenter trial to clarify the role of radiotherapy in the treatment of the primary tumor in small cell lung cancer stage limited disease. Patients were randomized to receive only chemotherapy (n = 27), or chemotherapy and radiotherapy of 30 Gy (n = 34) or chemotherapy and radiotherapy of 50 Gy (n = 30). Radiotherapy was administered after the third chemotherapy cycle. All patients received prophylactic total-brain irradiation of 30 Gy. The chemotherapy consisted of 6 cycles of adriamycin, cyclophosphamide and vincristin (ACO). 415 patients entered the trial. According to eligibility criteria 97 patients were randomized and 91 patients were evaluable for response. The total response rate (CR and PR) was 69% not being statistically different between all groups. No differences in survival time were observed between patients receiving 30 Gy (median = 13.5 months) and those receiving 50 Gy (median = 12.4 months). However patients treated with radiotherapy and chemotherapy showed a statistically significant improvement of survival time compared to patients receiving chemotherapy alone (median = 9.7 months).     

Rationale for surgery as the first step in the multimodality treatment of small cell lung cancer (SCLC)

The role of surgery has to be reconsidered in combination with chemo/radiotherapy for patients with SCLC at early stages, determined by the pTNM-staging system. This combined multimodality treatment can be seen as a model-like example for the most effective progress gained during the last 20 years. Surgery followed by chemotherapy is used in ongoing cooperative studies. In other trials, chemotherapy is followed by surgery for responding patients. It seems reasonable to expect that after appropriate observation times the comparison of these ongoing trials would most probably lead to the conclusion that for stage I, II surgery should be the first step followed by chemo- and radiotherapy, whereas for stage III debulking chemotherapy should be given to distinguish responding patients, who may thereafter receive adjuvant surgery.     

热疗联合化疗治疗晚期非小细胞肺癌临床研究

目的:比较热疗联合化疗治疗晚期非小细胞肺癌(NSCLC)的疗效及安全性。方法:将225例Ⅲb/Ⅳ病人1∶2∶4比例随机分为全身热疗联合化疗组、局部热疗联合化疗组、单纯化疗组。全身热疗采用SRI全身热疗系统,每周期1次;局部热疗采用HG-2000高频热疗机,每周期2次;化疗采用含铂两药联合方案。结果:无进展生存期(PFS):全身热疗组35例,(5.21±3.84)月;局部热疗组61例,(4.02±2.82)月;单纯化疗组129例,(3.49±2.75)月。全身热疗组PFS与单纯化疗组对比有显著统计学差异(P=0.003),也优于局部热疗联合化疗组(P=0.061)。局部热疗联合化疗组与单纯化疗组相比无显著统计学差异(P=0.255)。治疗相关毒副反应各组之间无统计学差异。结论:全身热疗联合化疗PFS优于单纯化疗及局部热疗联合化疗组,毒副反应可耐受,有望成为晚期NSCLC的辅助治疗方法。     

Pathologic findings of small cell lung cancer (SCLC) after chemotherapy--analysis of 48 cases

From 1980 to 1986, resected specimens from 48 SCLC patients after chemotherapy were studied pathologically. According to the pathologic changes, they were divided into four degrees: 1. The primary lesion disappeared and was replaced by fibrosis (6 cases, 12.5%); 2. Scanty residual cancer tissues were seen by microscopy (6 cases, 12.5%); 3. Degeneration and necrosis with fibrosis were present but active cancer tissues in small areas were found (18 cases, 37.5%), and 4. There was mild degeneration or no obvious changes (18 cases, 37.5%). Five specimens were examined by electron microscopy. The effect of chemotherapy in the primary lesion is more marked than that in the metastatic lymph nodes. The relationship between pathologic changes and response of chemotherapy and pathologic staging; comparison of clinical and pathologic staging and the prognosis of lymph node metastasis are discussed.     

放疗对局限期和广泛期小细胞肺癌化疗疗效的影响

目的：探讨放疗对局限期和广泛期小细胞肺癌化疗疗效的影响。方法 用寿命表法和Ｌｏｇ－Ｒａｒｋ法分析比较６１例化疗加入疗（化放组）和同期４６例单纯化疗（单化组）小细胞肺癌的生存率。结果：比放组病人１,３,５年生存率分别为７０．５％,２５．４％和１２．９％,而单化组分别为４０．７％,２．６％和２．６％,两组比较有显著差异（Ｐ〈０．０１）,在局限期病人中,化放组１－５年生存率明显高于单化组（Ｐ〈０．０２５     

93例广泛期小细胞肺癌（SCLC）综合治疗的预后因素分析

目的:回顾性分析我院93例广泛期SCLC放化综合治疗的疗效,对影响小细胞肺癌预后的多个因素进行分析。方法:选取2008年10月-2010年10月,陕西省肿瘤医院放疗科收治的经病理学或细胞学证实的93例广泛期SCLC患者,患者均采用放化综合治疗。对比风险模型进行多因素分析。主要收集患者的年龄、性别、分期、PS评分、转移部位、胸部放疗情况、化疗周期、预防性脑放疗情况,观察中位生存时间、总生存时间。结果:93例患者的1年生存率39.8%,2年生存率11.8%,3年生存率2.18%,中位生存期11.56个月。单因素分析显示PS评分、胸部放疗、预防性脑放疗、化疗周期数、脑转移对患者的生存期有影响。多因素分析显示PS评分、预防性脑放疗、化疗周期数是预测广泛期小细胞肺癌预后的因素。结论:对于广泛期小细胞肺癌患者PS评分<2、化疗周期数≥4、预防性脑放疗均提示其预后较好。     

CNS relapse despite prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC)

CNS relapse after PCI may reflect either suboptimal radiation dose schedules or reseeding from other sites of active disease. A retrospective study has been undertaken to investigate these alternative mechanisms of treatment failure. Between August 1981 and December 1983, 30 patients with SCLC treated by induction chemotherapy, followed by high-dose cyclophosphamide (7 Gm/m2), were selected for PCI on the basis of clinical, radiological, and bronchoscopic CR. Pretreatment CT brain scans were normal in all patients, and 20 Gy mid-plane dose in 5 daily fractions were delivered by lateral fields to whole brain using megavoltage X rays and localizing check films. Progressive focal neurological signs of cranial metastases developed in 7/30 (23%) patients 3-11 months after PCI, confirmed on CT scanning in 4 patients. Relapse at other sites, predominantly the thorax, occurred in all seven patients at intervals of 1-6 months prior to CNS relapse. Published clinical data of tumor volume doubling times in SCLC predict longer CNS relapse-free intervals after PCI than those observed in our patients if reseeding was responsible for relapse. This suggests that incomplete eradication of intracranial disease is the main cause of CNS relapse after PCI. Higher equivalent radiation doses may improve the results of PCI.     

重组人血管内皮抑制素联合ＴＣ方案治疗晚期非小细胞肺癌的临床观察

目的：观察重组人血管内皮抑制素（恩度）联合ＴＣ方案（紫杉醇＋卡铂）治疗晚期非小细胞肺癌（ＮＳＣＬＣ）的近期疗效及安全性。方法：采用ＴＣ＋恩度（试验组）和ＴＣ（对照组）治疗晚期ＮＳＣＬＣ共５３例,治疗２～６疗程。按照ＲＥＣＩＳＴ标准和ＮＣＩ ＣＴＣ标准分别评价疗效和毒性。结果：试验组有效率为５９.３％,疾病控制率为８１５％,对照组的有效率为３０.８％,疾病控制率为５３.８％。毒副反应主要有白细胞减少、血小板减少、恶心呕吐、肌肉关节酸痛和心血管毒性等。结论：恩度与ＴＣ方案联合治疗晚期ＮＳＣＬＣ的近期客观疗效较高,且安全性较好。     

A national survey of the chemotherapy regimens used to treat small cell lung cancer (SCLC) in the United Kingdom

Many chemotherapy regimens are used for treating SCLC in the United Kingdom, but it is not known, in any detail, which regimens are used, by which specialists, for which types of patient. We conducted a survey among all medical and clinical oncologists, respiratory physicians and general physicians with respiratory interest in the United Kingdom to find out. The questionnaire asked for the number of SCLC patients treated annually; how many were given chemotherapy; the drugs, doses and schedules chosen according to prognostic group (as defined by the clinician); and the reasons for choice of regimen. 1214 questionnaires were sent out, and responses were received from 1070 (88%) clinicians; 266 (25%) of these treated SCLC with chemotherapy. Of 4674 patients given chemotherapy annually, 36% were given it by clinical oncologists, 30% by medical oncologists, 27% by respiratory physicians, and 7% by general physicians. In all, 34 regimens were reported with 151 different combinations of dose and schedule. In 2311 good prognosis patients, 23 regimens were used, the commonest being ACE (doxorubicin, cyclophosphamide, etoposide), ICbE (ifosfamide, carboplatin, etoposide), CAV (cyclophosphamide, doxorubicin, vincristine), CbE (carboplatin, etoposide), and PE (cisplatin, etoposide). In 1517 poor prognosis patients, 21 regimens were used, the commonest being CAV, EV (etoposide, vincristine), CbE, CAV alternating with PE, and oral etoposide. 452 patients were treated regardless of prognosis and for 219 no prognostic criteria were specified. The remaining 175 were given second-line chemotherapy or were given regimens chosen to avoid toxicity or because of intercurrent disease or other reasons. The main reasons affecting choice of regimen were routine local practice, patients' convenience, quality of life considerations, trial results and cost. The results show wide variation in routine practice and will be useful in reporting and planning clinical trials and in deciding on local treatment policies.