High Frequency of Radiation Pneumonitis in Patients with Locally Advanced Non-small Cell Lung Cancer Treated with Concurrent Radiotherapy and Gemcitabine after Induction with Gemcitabine and Carboplatin
High Frequency of Radiation Pneumonitis in Patients with Locally Advanced Non-small Cell Lung Cancer Treated with Concurrent Radiotherapy and Gemcitabine after Induction with Gemcitabine and Carboplatin
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DOI：
10.1097/jto.0b013e3181a97e17
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发表时间：
2009-07-01
影响因子：
20.4
通讯作者：
de la Garza, Jaime
中科院分区：
文献类型：
--
作者：
Arrieta, Oscar;Gallardo-Rincon, Dolores;de la Garza, Jaime
简介：化疗和胸部放疗的组合是局部晚期非小细胞肺癌（NSCLC）的标准治疗。然而，最有利的化疗方案，全剂量化疗的时机，化疗与放疗的最佳组合仍有待确定。我们的主要目的是评估吉西他滨联合卡铂诱导化疗后吉西他滨联合放疗治疗局部晚期NSCLC的疗效和安全性。经组织学证实的IIIA和-B期NSCLC患者接受卡铂治疗（2.5曲线下的面积）和吉西他滨（800 mg/m2），第1天和第8天，每21天一次，共2个周期，随后进行常规分割胸部放疗，同时每周给予吉西他滨200 mg/m2，结果：由于发生3 - 5级放射性肺炎事件（19例患者中有6例，31.6%），包括1例与放射性肺炎相关的治疗相关死亡，因此停止纳入研究。中位随访时间为11.9个月。诱导期间最常见的3/4级血液学副作用包括贫血、中性粒细胞减少症（各3/19例，15.8%）和血小板减少症（4/19例，21.1%）。诱导化疗后部分缓解10例（52.6%）。同步放化疗后，总有效率为68.4%。4例患者（21.1%）接受手术切除。中位无进展生存期和总生存期为12 +/- 1个月（95%置信区间[CI]，9.8-14.1）和21 ± 3.5个月结论：吉西他滨联合卡铂诱导后同步放疗有效率高;然而，它与过度的肺毒性有关。放疗期间调整吉西他滨剂量或改变放疗计划可降低毒性。
Introduction: The combination of chemotherapy and thoracic radiation is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, most favorable chemotherapy regimen, timing of full-dose chemotherapy, and optimal combination of chemotherapy with radiation remain to be determined. Our primary objective was to evaluate the efficacy and safety of gemcitabine concurrent with radiotherapy after induction chemotherapy with gemcitabine plus carboplatin for locally advanced NSCLC.Patients and Methods: Patients with histologically proven NSCLC stage IIIA and -B received carboplatin (area tinder the curve of 2.5) and gemcitabine (800 mg/m(2)) on days 1 and 8, every 21 days for two cycles, followed by conventional fractioned thoracic radiotherapy and concomitant weekly gemcitabine 200 mg/m(2), and finally, consolidation chemotherapy.Results: Inclusion was discontinued because of high-grade 3 to 5 radiation-pneumonitis events (6 of 19 patients, 31.6%), including one treatment-related death associated with radiation pneumonitis. Median follow-tip was 11.9 months. Most common grades 3/4 hematological side effects comprised anemia, neutropenia 3 of 19 patients, each (15.8%), and thrombocytopenia (4 of 19, 21.1%) during induction. Partial response was observed in 10 patients (52.6%) following induction chemotherapy. After concurrent chemo-radiotherapy, overall response was 68.4%. Four patients (21.1%) underwent surgical resection. Median progression-free survival and overall survival were 12 +/- 1 month (95% confidence interval [CI], 9.8-14.1) and 21 +/- 3.5 months (95% CI, 14-27.9 months), respectively.Conclusion: Concurrent radiotherapy with gemcitabine after induction with gemcitabine and carboplatin showed a high-response rate; however, it is associated with excessive pulmonary toxicity. Adjustments in gemcitabine dosage during radiotherapy or changes in radiotherapy planning could reduce toxicity.