CONCURRENT CISPLATIN/ETOPOSIDE PLUS CHEST RADIOTHERAPY FOLLOWED BY SURGERY FOR STAGES IIIA(N2) AND IIIB NON-SMALL-CELL LUNG-CANCER - MATURE RESULTS OF SOUTHWEST-ONCOLOGY-GROUP PHASE-II STUDY-8805
CONCURRENT CISPLATIN/ETOPOSIDE PLUS CHEST RADIOTHERAPY FOLLOWED BY SURGERY FOR STAGES IIIA(N2) AND IIIB NON-SMALL-CELL LUNG-CANCER - MATURE RESULTS OF SOUTHWEST-ONCOLOGY-GROUP PHASE-II STUDY-8805
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DOI：
10.1200/jco.1995.13.8.1880
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发表时间：
1995-08-01
影响因子：
45.3
通讯作者：
LIVINGSTON, RB
中科院分区：
文献类型：
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作者：
ALBAIN, KS;RUSCH, VW;LIVINGSTON, RB
目的：在癌症治疗协作组（ct cooperative group）的环境下，评估局部晚期非小细胞肺癌（NSCLC）同步放化疗（chemoRT）后手术的可行性，并评估ⅢA（N2）期与ⅢB期亚组的疗效、切除率、复发模式和生存率。
患者与方法：需要有N2淋巴结阳性（ⅢA N）或N3淋巴结或T4原发肿瘤（ⅢB）的活检证明。诱导治疗为两个周期的顺铂和依托泊苷联合同步胸部放疗至45Gy。如果出现疗效或病情稳定则尝试手术切除，如果发现肿瘤不可切除或切缘或淋巴结阳性则给予放化疗强化。
结果：126例符合条件的患者（75例ⅢA（N2）期和51例ⅢB期）的中位随访时间为2.4年。诱导治疗的客观有效率为59%，29%病情稳定。符合手术条件的ⅢA（N2）组可切除率为85%，ⅢB组为80%。13%的患者出现可逆的4级毒性反应。有13例（10%）治疗相关死亡，19例（15%）死于与毒性或肿瘤无关的原因。在65例复发中，11%仅为局部区域复发，61%仅为远处复发。有26例脑部复发，其中19例是唯一的复发部位或死亡原因。ⅢA（N2）期与ⅢB期之间生存率无差异（P = 0.81）（中位生存期分别为13个月和17个月；2年生存率分别为37%和39%；3年生存率分别为27%和24%）。开胸手术后长期生存的最强预测因素是手术时纵隔淋巴结无肿瘤（中位生存期分别为30个月和10个月；3年生存率分别为44%和18%；P = 0.0005）。
结论：在这项西南肿瘤学组（SWOG）的研究中，这种三联疗法是可行的，3年生存率达26%令人鼓舞。目前正在进行一项组间研究，以确定手术对放化疗的风险或益处是否有更多影响。
《临床肿瘤学杂志》13卷：1880 - 1892页。（C）1995年美国临床肿瘤学会出版。
Purpose: To assess the feasibility of concurrent chemotherapy and irradiation (chemoRT) Followed by surgery in locally advanced non-small-cell lung cancer (NSCLC) in ct cooperative group setting, and to estimate response, resection rates, relapse patterns, and survival for stage subsets IIIA(N2) versus IIIB.Patients and Methods: Biopsy proof of either positive N2 nodes (IIIAN) or of N3 nodes or T4 primary lesions (IIIB) was required. induction was two cycles of cisplatin and etoposide plus concurrent chest RT to 45 Gy. Resection was attempted if response or stable disease occurred, A chemoRT boost was given if either unresectable disease or positive margins or nodes was found.Results: The median follow-up time for 126 eligible patients [75 stage IIIA(N2) and 51 IIIB] was 2.4 years. The objective response rate to induction was 59%, and 29% were stable. Resectability was 85% for the IIIA(N2) group eligible for surgery and 80% for the IIIB group. Reversible grade 4 toxicity occurred in 13% of patients. There were 13 treatment-related deaths (10%) and 19 others (15%) died of causes not related to toxicity or tumor. Of 65 relapses, 11% were only locoregional and 61% were only distant, There were 26 brain relapses, of which 19 were the sole site or cause of death. There was no survival difference (P = .81) between stage IIIA(NZ) versus stage IIIB (median survivals, 13 and 17 months; 2-year survival rates, 37% and 39%; 3-year survival rates, 27% and 24%). The stongest predictor of long-term survival after thoracotomy was absence of tumor in the mediastinal nodes at surgery (median survivals, 30 v 10 months; 3-year survival rates, 44% v 18%; P = .0005).Conclusion: This trimodality approach was feasible in this Southwest Oncology Group (SWOG) study, with an encouraging 26% 3-year survival rate. An intergroup study is currently being conducted to determine whether surgery adds more to the risk or to the benefit of chemoRT.J Clin Oncol 73:1880-1892. (C) 1995 by American Society of Clinical Oncology.