同期放化疗治疗肺癌所致上腔静脉综合征临床研究

目的应用同期放化疗治疗肺癌所致上腔静脉综合征,以期提高疗效及安全性。方法对符合入组病例,经一般处理后,予诱导化疗2周期,小细胞肺癌(SCLC)应用EP方案:DDP 20 mg/ m~2,静脉滴注,d1～4;Vp-16 100 mg/m~2,静脉滴注,d 5～7。非小细胞肺癌(NSCLC)应用GP方案:GEM 1000 mg/m~2,静脉滴注,d1、8;DDP 20 mg/m~2,静脉滴注,d2～4。同期放化疗:诱导化疗结束1～2周后无放疗禁忌证,可予以同期放化疗:DDP 20 mg/m~2,静滴,d1～4,3周后重复,共2周期。同时予以肺部病灶加纵隔及双锁上根治性放疗,每次300～400 cGy,每日应用地塞米松5 mg,2～4次后再改为200 cGy/d。照射剂量应视肿瘤的病理类型而定。小细胞肺癌(SCLC)3000～3500 cGy/3～4周,非小细胞肺癌(NSCLC)及未分型5000～6000 cGy/5～6周,其间注意放化疗毒副应及并发症的处理。补充化疗:同期放化结束后,休息3～4周,应进行补充化疗。据不同病理类型采用不同的化疗方案及疗程。小细胞肺癌予以CAO、EP、CE等方案化疗4～6周期,非小细胞肺癌予以NP、GP、TP等方案化疗2～3周期,未分型采用EP方案化疗3～4周期。结果入组53例,51例可评价疗效,临床症状缓解率为89.6%。CR 6例,PR 33例,NC 9例,PD 5例,有效率为73.6%。1年生存率56.3%,2年生存率33.9%,3年生存率9.4%。结论此种治疗模式可作为肺癌合并SVCS的规范治疗模式,亦可对其他恶性肿瘤合并SVCS的治疗有较好的指导作用。

Clinical study of SVCS caused by lung cancer in synchronous chemotherapy and radiotherapy

Objective To treat the superior vena cava syndrome (SVCS) caused by lung cancer treated with synchronous chemotherapy and radiotherapy,in expecting to improve the efficacy and safety. Methods All enrolled cases received inductive chemotherapy after regular management.EP regimen was conducted in NSCLC group:GEM 1000 mg/m~2 iv infusion d1 and d8;DDP 20 mg/m~2 iv infusion d2-4.The synchronous chemotherapy and radiotherapy were conducted 1-2 weeks after inductive chemotherapy if the patients had no contraindication of radiotherapy:DDP 20 mg iv infusion d1-4,the protocol was repeated every 3 weeks for two cycles.Meanwhile,radical radiotherapy of the lung lesions plus mediastinal field and both sides of supraclavicular field was given,300-400 cGy/day,reducing to 200 cGy/d after 2-4 times,and dexa- methasone 5 mg/day was supplied.The dosage for radiotherapy was determined according to the histology type of tumor:SCLC 3000-3500 cGy/3-4 weeks,both NSCLC and the undifferentiated lung cancer 5000- 6000 cGy/5.6 weeks.The adverse reactions of chemotherapy and complications were watched throughout the course.Complementary chemotherapy:Complementary chemotherapy was administered 3-4 weeks after syn- chronous chemotherapy and radiotherapy.Chemotherapy program and cycles were determined according to different histological diagnosis.CAO,EP and CE were administered to SCLC patients for 4-6 cycles,NP,GP and TP to NSCLC patients for 2-3 cycles,EP to the undifferentiated lung cancer patients for 3-4 cycles. Results The objective response rate was evaluated in 51 cases.The clinical sign-relieving rates were 89.6%.There were 6 cases with CR,33 PR,9 NC,5 PD,with response rate (CR PR) 73.6% (39/53).1- Year survival rate was 56.3%,2-year 33.9%,3-year 9.4%.Conclusion The program may be used as a standard modality for therapy of lung cancer-caused SVCS,and may be helpful to other malignancy-coupling SVCS.