Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small-cell lung cancer:: Mature results of a phase II trial
Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small-cell lung cancer:: Mature results of a phase II trial
复制标题
DOI：
10.1200/jco.1998.16.2.622
复制
发表时间：
1998-02-01
影响因子：
45.3
通讯作者：
Seeber, S
中科院分区：
文献类型：
--
作者：
Eberhardt, W;Wilke, H;Seeber, S
目的：评价联合化疗、超分割加速放化疗和确定性手术的强化多模式方法在局部晚期非小细胞肺癌IIIA期和IIIB期患者中的可行性和疗效患者和方法：分期后，包括纵隔镜检查，94例不能手术的LAD-NSCLC患者术前接受化疗（三个疗程的顺铂和依托泊苷[PE]分次给药），随后进行同步放化疗（1个疗程PE +45戈伊超分割加速放疗）。在重复纵隔镜检查后，患者在放射后4周接受手术。在94名连续患者中（52例IIIA期[累及≥ 2个淋巴结水平]和42例IIIB期[无胸腔积液，无锁骨上淋巴结]），62例（66%）完成诱导并接受手术，50例实现完全切除（RO）病理完全缓解（PCR）24例（26%）。中位随访43个月后，IIIA患者的中位生存时间为20个月，IIIB患者为18个月，RO患者为42个月。计算的4年生存率分别为31%、26%和46%。2例患者术前死于败血症，4例患者术后死于胸腔积脓（n = 1）、残端功能不全（n = 2）和心力衰竭（n = 1）。其他毒副反应是可以接受的主要是血液在化疗或放化疗和食管炎在chemoradiotherapy.Conclusion：这种密集的多模式治疗是可行的，并表现出较高的疗效，在approximately LAD-NSCLC亚组与高RO率和改善长期生存与历史对照。(C)1998年，美国临床肿瘤学会。
Purpose: To evaluate the feasibility and efficacy of an intensive multimodality approach with combination chemotherapy, hyperfractionated accelerated chemoradiotherapy, and definitive surgery in prognostically unfavorable subgroups of locally advanced non-small-cell lung cancer stages IIIA and IIIB (LAD-NSCLC).Patients and Methods: Following staging, including mediastinoscopy, 94 patients with inoperable LAD-NSCLC were treated preoperatively with chemotherapy (three courses of split-dose cisplatin and etoposide [PE]) followed by concurrent chemoradiotherapy (one course of PE combined with 45 Gy hyperfractionated accelerated radiotherapy). After repeat mediastinoscopy, patients underwent surgery 4 weeks postradiation.Results: Of 94 consecutive patients (52 stage IIIA [greater than or equal to two lymph node levels involved] and 42 stage IIIB [no pleural effusion, no supraclavicular nodes]), 62 (66%) completed induction and underwent surgery Complete resection (RO) was achieved in 50 (53% of all patients) and pathologic complete response (PCR) in 24 (26%). After a median follow-up of 43 months, the median survival time was 20 months for IIIA, 18 months for IIIB, and 42 months for RO patients. Calculated survival rates at 4 years were 31%, 26%, and 46%. Two patients died of sepsis preoperatively and four died postoperatively of pleural empyema (n = 1), stump insufficiency (n = 2), and cardiac failure (n = 1). Other toxicities were accept able-mainly hematologic during chemotherapy or chemoradiotherapy and esophagitis during chemoradiotherapy.Conclusion: This intensive multimodality treatment is feasible and demonstrates high efficacy in prognostically unfavorable LAD-NSCLC subgroups with high RO rates and improved long-term survival compared with historical controls. (C) 1998 by American Society of Clinical Oncology.