Hospitalization During Chemotherapy for Small Cell Lung Cancer

Ninety patients with small cell lung cancer, who received combination chemotherapy, were studied with regard to hospitalization during the treatment period. Chemotherapy was discontinued in case of tumour progression, or, if progression did not occur, after 18 months. The mean hospitalization time was 18 days per patient which constituted 6.7% of the total tretment time in all 90 patients. The hospitalization rate significantly decreased during the first 10 weeks of treatment, and then remained constantly low, with an average hospital time of 3.7 days per patient during maintenance chemotherapy, accounting for 2% of the total maintenance treatment time. Tumour-associated disability was a major purpose for hospital admissions, accounting for 69% of the hospital time during treatment. Except for the first treatment course, which was routinely given in hospital, chemotherapy was administered on an out-patient basis, and only four patients were admitted to hospital to receive maintenance treatment. In these patients, comorbidity and long-distance living may have contributed to the need for hospitalization. Sixteen patients were admitted to hospital at different times of treatment because of treatment complications, mainly severe infections and haemorrhages. It is concluded, that hospitalization rate is a useful and easily understood treatment outcome measure, which, in our study, implied that patients who responded to chemotherapy also gained an improved social mobility in terms of days outside the hospital, although this should not be interpreted as a comprehensive quality of life measure.     

Effect of Hospitalization During First Chemotherapy and Performance Status on Small-cell Lung Cancer Outcomes

IntroductionSmall-cell lung cancer (SCLC) is highly responsive to chemotherapy (CT) and one of the few malignancies treated in hospitalized patients with poor Eastern Cooperative Oncology Group (ECOG) performance status (PS). Because of the little current information available on the outcomes experienced by hospitalized patients with SCLC receiving CT, we explored the outcomes for these patients to improve the evidence base for practice.Materials and MethodsWe conducted a retrospective cohort study to evaluate patients with a diagnosis of SCLC and treated with CT during a 10-year period. Progression-free survival (PFS) and overall survival (OS) were evaluated according to site of first CT (inpatient vs. outpatient) and PS. Multivariable analysis was completed to assess for independent survival predictors.ResultsA total of 530 patients with SCLC were treated, with 82 (15%) receiving their first CT in hospital. Inpatients had a greater burden of disease and poorer PS. Neutropenia, thrombocytopenia, nephrotoxicity, and fatigue were all experienced less often by the inpatient cohort (P < .001, P < .001, P < .001, and P = .007, respectively). For inpatients and outpatients, the OS rate at 12, 24, and 60 months was 22%, 9%, and 7% and 43%, 20%, and 9%, respectively (P < .001 for all). The median PFS and OS were longer for outpatients and highly functional patients. On multivariable analysis, ECOG PS was an independent predictor of the outcome and the site of first CT was not (P = .04 and P = .49, respectively).ConclusionPatients with SCLC initially treated as inpatients and those with poor functional status had shorter PFS and OS; however, some experienced long-term survival, including 5-year survival of 7% for the inpatient cohort and 5% for the ECOG PS 3-4 cohort. CT toxicities were less common in the inpatient cohort, validating that administration of CT in hospital should be considered for these patients because they could experience a meaningful long-term response to therapy.     

重组人血管内皮抑素联合化疗治疗晚期NSCLC近期疗效观察

目的 观察抗肿瘤新药重组人血管内皮抑素注射液联合化疗治疗晚期NSCLC的有效性和安全性。方法 经组织学或细胞学确诊的Ⅲb~Ⅳ期NSCLC患者104例,分为2组。试验组41例接受重组人血管内皮抑素加常规化疗药物联合治疗,对照组63例接受单纯常规化疗。按照RECIST标准评价近期客观疗效,按照NCI CTC 3.0版的分级标准评价药物毒性。治疗2周期后评价毒性和近期疗效。结果 所有104例患者均可评价疗效。试验组和对照组的总临床有效率(RR)分别为34.15%和30.16%,实验组较对照组高,总临床获益率 (CBR) 分别为73.17%和71.43%;初治患者RR分别为34.78%和39.02%,CBR分别为73.91%和80.49%;复治患者RR分别为33.33%和13.64%,CBR分别为72.22%和54.55%;腺癌比鳞癌效果好,在同一病理类型中试验组与对照组疗效相似,鳞癌患者RR分别为27.27%和28.00%,CBR分别为81.82%和72.00%;腺癌患者RR分别为36.67%和31.58%,CBR分别为70.00%和71.05%。试验组与对照组患者在症状、Karnofsky评分、体重三方面差异均无统计学意义(P>0.05)。试验组与对照组均未出现严重不良反应,Ⅲ~Ⅳ度不良反应发生率差异无统计学意义(P>0.05)。结论 重组人血管内皮抑素联合化疗治疗晚期NSCLC耐受性好,可以提高化疗的有效率,用于复治时疗效提高更为显著。     

Randomized Trial Comparing Chemotherapy Alone and Chemotherapy Plus Chest Irradiation in Limited Stage Small Cell Lung Cancer: A Preliminary Report

In order to assess the effectiveness of chest irradiation inaddition to intensive chemotherapy in limited stage small celllung cancer, 50 patients were randomized to receive either chemotherapyalone or chemotherapy plus chest irradiation, between April1981 and October 1985. The chemotherapy regimen consisted ofa four-drug combination of cyclophosphamide, vincristine, methotrexate,and procarbazine, and a three-drug combination of etoposide,adriamycin, and nimustine, given alternately every 8 weeks.One group of 26 patients received the chemotherapy alone, andanother group of 24 patients received chest irradiation with40 Gy between cycles 1 and 2 of the chemotherapy. Complete responserates were quite similar in the two groups; 50% for those receivingchemotherapy alone, and 59% for those receiving chemotherapyplus chest irradiation. There were no significant differencesin median survival (15 months versus 12 months) and in long-termsurvival rates between the two groups with a median follow-upperiod of 26 months. The combined modality treat ment was moretoxic than chemotherapy aIone two patients receiving such treatmentdied of radiation pneumonitis. It is concluded that chest irradiationcombined with chemotherapy does not affect the response rate,survival, or pattern of recurrence in patients with limitedstage small cell lung cancer.     

中医辨证分型在中晚期肺癌化疗中的临床研究现状

中医药现已被当作中晚期肺癌不可缺少的治疗手段。谈及中医药的治疗，必然涉及具备中医特色的辨证分型及辨证论治问题，现就近年来中晚期肺癌的中医辨证分型及其在患者化疗中的临床应用作一综述。     

Ⅲ期非小细胞肺癌术前新辅助化疗的随机对照临床试验

目的:探讨术前新辅助化疗治疗Ⅲ期非小细胞肺癌的可行性和不良反应,同时评价其在病期下调率、提高手术切除率及患者生存率中的作用.方法:从1990年1月～2002年1月,对456例Ⅲ期非小细胞肺癌进行前瞻性随机对照试验,234例被随机分入术前新辅助化疗组(试验组),行术前化疗2个周期,其中47例行Gem DDP方案,35例NVB DDP方案,86例MVP方案,66例EP方案化疗.化疗结束后4周手术.另222例被随机分入对照组的患者则先行手术治疗.结果:试验组化疗总有效率为67.95%(159/234),病期下调率为35.04%(82/234).手术切除率试验组为87.02%(18l/208),对照组为83.78%(186/222).两组手术并发症和手术死亡率无显著性差异(P＞0.05).新辅助化疗组术后l、3、5年生存率分别为76.07%、52.99%和34.18%,对照组分别为69.82%、41.44%和22.97%.试验组术后生存率显著高于对照组(P＜0.01).结论:术前新辅助化疗安全、有效,能降低Ⅲ期非小细胞肺癌的病期,提高手术切除率,改善患者术后长期生存率和生活质量.     

3D-CRT结合同步化疗治疗Ⅲ期非小细胞肺癌的随机分组研究

[目的]研究三维适形放射治疗（3D-CRT）大剂量分割同步给予铂类为主的化学药物治疗不能切除的Ⅲ期非小细胞肺癌（NSCLC）的可行性。[方法]自2000年8月至2003年6月，将90例符合入选条件的Ⅲ期非小细胞肺癌患者随机分为3组，1组30例，以铂类为主的化疗＋3D-CRT常规分割组；2组30例，为单纯3D-CRT常规分割组；3组30例，以铂类为主的化疗＋3D-CRT大剂量分割组。1、2组分割剂量1．8—2Gy／次，5次/周，总剂量66～66．6Gy／6～8周，3组4．5～5Gy／次，3次/周，总剂量45Gy／4～5周.[结果]1、2、3组的3年总生存率和无病生存率分别为33.3％、20．0％、36．6％和23.3％、16．6％、23．3％，中位生存期分别为31、20、32个月。1、3组明显好于2组（1组和2组比较．Х^2=3．87．P=0．0492；2组和3组比较，Х^2=4．28．P=0．0387）．2组的中位转移时间为22个月，与1组的31．5个月、3组的30．5个月比较，有显著性统计学意义（1组和2组比较Х^2=4．71，P=0．0301；2、3组比较Х^2=4．02，P=0．0449）。1、2、3组的中位复发时间分别为27．5、32、28个月，无显著性统计学差异（1、2组比较Х^2=0．42，P=0．5177；1、3组比较Х^2=0．001，P=0．9636；2、3组比较Х^2=0．44，P=0．5066）。急性放射性食管炎：1、2、3组的发生半分别为46．7％、43．3％、63．3％。1、2、3组发生放射性肺炎的例数接近（Х^2=1．440，P=0．487），以Ⅰ级反应为主。[结论]3D-CRT联合化疗降低了Ⅲ期非小细胞肺癌患者的远处转移率，提高了总生存率和无病生存率。大剂量分割结合同步化疗可缩短疗程．提高局部控制率．但发生早期和晚期放射性损伤的概率增加．     

西艾克联合化疗治疗非小细胞肺癌

 用西艾克（长春地辛，VDS）为主的联合化疗方案治疗中晚期非小细胞肺癌，（NSCLC）38例，结果总有效率达55．2％，CR1例，PR20例。毒副反应白细胞下降和胃肠道反应为最常见，但均以Ⅰ－Ⅱ度为主，其它毒性都很少，病人耐受良好。     

Phase I Trial of Pembrolizumab and Radiation Therapy after Induction Chemotherapy for Extensive-Stage Small Cell Lung Cancer

IntruductionRadiation and immunotherapy have separately been shown to confer survival advantages to patients with extensive-stage small cell lung cancer (ESCLC), but failure rates remain high and combination therapy has been understudied. In this single-arm phase I trial (NCT02402920), we assessed the safety of combining pembrolizumab with thoracic radiotherapy (TRT) after induction chemotherapy for SCLC.MethodsPatients with ESCLC who had completed chemotherapy received TRT with pembrolizumab. The maximum tolerated dose of pembrolizumab was assessed by 3+3 dose-escalation; doses began at 100 mg and increased in 50 mg increments to 200 mg. Pembrolizumab was given every 3 weeks for up to 16 cycles; TRT was prescribed as 45 Gy in 15 daily fractions. Toxicity was evaluated with the Common Terminology Criteria for Adverse Events v4.0. The primary endpoint was safety of the combined therapy based on the incidence of dose-limiting toxicity in the 35 days following initiation of treatment.ResultsThirty-eight patients with ESCLC (median age 65 years, range: 37–79 years) were enrolled from September 2015 through September 2017; 33 received per-protocol treatment, and all tolerated pembrolizumab at 100 to 200 mg with no dose-limiting toxicity in the 35-day window. There were no grade 4-5 toxicities; 2 (6%) patients experienced grade 3 events (n = 1 rash, n = 1 asthenia/paresthesia/autoimmune disorder) that were unlikely/doubtfully related to protocol therapy. The median follow-up time was 7.3 months (range: 1–13 months); median progression-free and overall survival times were 6.1 months (95% confidence interval: 4.1–8.1) and 8.4 months (95% confidence interval: 6.7-10.1).ConclusionsConcurrent pembrolizumab-TRT was tolerated well with few high-grade adverse events in the short-term; progression-free and overall survival rates are difficult to interpret due to heterogeneity in eligibility criteria (e.g., enrolling progressors on induction chemotherapy). Although randomized studies have shown benefits to TRT alone and immunotherapy alone, the safety of the combined regimen supports further investigation as a foundational approach for future prospective studies.     

非小细胞肺癌术后辅助化疗的共识

近年来有关非小细胞肺癌术后辅助化疗的治疗标准发生了显著变化,越来越多的前赡性、大样本随机临床试验和多项荟萃分析均证实辅助化疗,特别是新一代化疗药物的含铂联合方案能显著提高化疗反应和总体生存期,降低死亡危险比,且毒性反应均可耐受.因此,对于完整手术后的非小细胞肺癌,特别是Ⅰ B～Ⅱ期的患者采用辅助化疔是合理治疗方案.     

Short-Term Preoperative High-Intensity Interval Training in Patients Awaiting Lung Cancer Surgery: A Randomized Controlled Trial

IntroductionImpairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications.MethodsPatients with operable lung cancer were randomly assigned to usual care (UC) (n = 77) or preoperative rehabilitation based on HIIT (Rehab) (n = 74). Maximal cardiopulmonary exercise testing and the 6-minute walk test were performed twice before surgery. The primary outcome measure was a composite of death and in-hospital postoperative complications.ResultsThe groups were well balanced in terms of patient characteristics. During the preoperative waiting period (median 25 days), the peak oxygen consumption and the 6-minute walking distance increased (median +15%, interquartile range, 25th to 75 percentile [IQR25%–75%, %] = +9% to +22%, p = 0.003 and +15%, IQR25%–75% = +8% to +28%, p < 0.001, respectively) in the Rehab group, whereas peak oxygen consumption declined in the UC group (median –8%, IQR25%–75% = –16% to 0%], p = 0.005). The primary end point did not differ significantly between the two groups: at least one postoperative complication developed in 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group (p = 0.080). Notably, the incidence of pulmonary complications was lower in the Rehab compared with in the UC group (23% versus 44%, p = 0.018), owing to a significant reduction in atelectasis (12.2% versus 36.4%, p < 0.001), and this decrease was accompanied by a shorter length of stay in the postanesthesia care unit (median –7 hours, IQR25%–75% = –4 to –10).ConclusionsIn this randomized controlled trial, preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.     

北京市12 099例肺部恶性肿瘤患者住院费用及影响因素分析

摘 要：［目的］ 研究影响肺部恶性肿瘤患者住院费用的主要因素。［方法］ 选取北京市30家医院2016年肺部恶性肿瘤住院患者的信息,提取基本情况、住院治疗情况和费用情况等数据信息,采用单因素方差分析和多元逐步回归分析的方法对住院费用的影响因素进行统计分析。 ［结果］ 共收集12 163例肺部恶性肿瘤住院患者,有效例数为12099。结果显示：药品费、医疗费和耗材费分别占住院费用的43.93%、32.78%和23.29%。多元逐步回归分析显示,住院总费用影响因素按作用由大到小依次为：住院天数、医院类型、支付方式和年龄。 ［结论］ 有效降低西药费用是降低肺部恶性肿瘤患者住院费用的一个主要举措。通过降低住院天数、完善转诊制度和改变支付方式等一些具体措施,可以有效降低肺部恶性肿瘤患者的住院费用。     

Chemotherapy and Endocrine Function in Lung Cancer

to investigate whether cyclic chemotherapy for lung cancer influenced endocrine function, we monitored thyroxine, cortisol, testosterone, sex hormone binding globulin (SHBG), estradiol, FSH, LH, and transcortin every three weeks in 12 male patients. Treatment regimens consisted of cisplatin and etoposide in 9 patients, or vincristine, doxorubicin, and cyclophosphamide in 3 patients. SHBG and FSH levels were significantly elevated after 6 to 9 weeks of therapy, whereas the other variables were unchanged. the results suggest that the therapy induces endocrine gonadal dysfunction. the increments in SHBG levels reflect a considerable fall in free testosterone, and may effect alterations in total androgedestrogen ratios. the mechanism underlying the increased SHBG levels is unknown.     

榄香烯乳联合化疗治疗肺癌临床观察

目的：探讨榄香烯乳联合化疗治疗肺癌的疗效。方法：应用榄香乳联合吡柔比星（ＴＨＰ－ＡＤＭ）和环磷酰胺（ＣＴＸ）治疗中晚期原发性肺癌２５例,至少３个疗程以 。结果ＣＲ１２％（３／２５）,ＰＲ５６％（１４／２５）,ＣＲ＋ＰＲ６８％。结论：ＴＨＰ－ＡＤＭ心脏毒性及其它毒性均较低,尤其是榄香烯乳具有较强的杀伤肿瘤细胞功能,同时有升白细胞、增强机体免疫力的作用,对肿瘤细胞不产生抗药性,副反应少,可长期应用。     

肺癌日间化疗的安全性分析

背景与目的 日间化疗因具经济成本低、毒副反应不高的特点成为发达国家普遍采用的一种化疗模式,本文探讨上海市胸科医院日间化疗模式的可行性及安全性,为今后日间化疗模式的推广提供借鉴.方法 对所有入住日间化疗病房和普通化疗病房患者进行统计和记录,主要内容包括患者一般状况、化疗次数、病理类型、住院期间毒副反应、出院后出现的毒副反应.结果 2008年10月-2009年4月,我院日间病房共收治化疗患者416人次,普通病房共收治患者1 157人次,两组化疗的毒副反应总体差异不大,日间化疗患者的II度以上胃肠道反应(21.88%)较住院患者低(38.89%)(P<0.01),白细胞降低比例(49.28%)较住院患者(35.0%)为多(P<0.01),日间化疗病房住院天数缩短(4.48天vs 14.04天,P<0.01),医疗支出也大大降低(6911.32元vs 14 623.59元,P<0.01).结论 日间化疗的住院时间和费用缩短,主要毒副反应为白细胞降低,化疗的累积毒性是其主要原因,需要引起注意,其它毒副反应未见明显差异,日间化疗是一种值得推广和借鉴的方式.     

非小细胞肺癌术后辅助化疗的再认识

非小细胞肺癌（NSCLC）术后辅助化疗的地位虽然较为确切,但疗效并不显著,尤其在早期患者中获益不明显,远期结果有待于进一步观察。同时该治疗也受到靶向药物治疗的严峻挑战。在生物标志物的指导下个体化化疗以及与靶向药物结合的联合化疗将成为发展的趋势。     

非小细胞肺癌个体化化疗研究进展

随着肿瘤分子生物学的发展,已经发现核苷酸切除修复交叉互补组1,核苷酸还原酶调节因子1,Ⅲ型β微管蛋白及胸苷酸合成酶的表达水平和化疗药物疗效密切相关,成为预测疗效进行个体化化疗的重要分子标志物。