Accelerated regrowth of non-small-cell lung tumours after induction chemotherapy.
Accelerated regrowth of non-small-cell lung tumours after induction chemotherapy.
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诱导化疗后，非小细胞肺肿瘤的加速再生。
DOI：
10.1038/sj.bjc.6601418
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发表时间：
2003-12-15
影响因子：
8.8
通讯作者：
Battermann, J J
中科院分区：
文献类型：
--
作者：
El Sharouni, S Y;Kal, H B;Battermann, J J
非小细胞肺癌（NSCLC） III期联合吉西他滨和顺铂诱导化疗以降低肿瘤分期，目的是进一步进行电离辐射治疗，是肺癌患者的治疗方法之一。本研究的目的是探讨放疗等待时间，即诱导化疗与放疗的间隔时间对NSCLC患者肿瘤生长速度的影响。对23例非小细胞肺癌患者进行诱导化疗结束至诊断CT、计划CT及放疗第一天的间隔时间。通过在诱导化疗后的诊断CT和用于放疗计划的CT上测量原发肿瘤和淋巴结转移的尺寸，测量18例患者的总肿瘤体积的增加。对于每个患者，根据两次CT之间的时间间隔和计划CT与诊断CT的总体积之比计算容积倍增时间。化疗结束至CT诊断日的平均间隔时间为16天，至放疗第一天的平均间隔时间为80.3天（29 ~ 141天）。总的来说，41%可能治愈的病人在等待期间变得无法治愈。两组ct的肿瘤总体积比为1.1 ~ 81.8，肿瘤翻倍时间为8.3 ~ 171天，平均值为46天，中位数为29天。这远远小于文献中发现的未经治疗的NSCLC患者的平均倍增时间。本研究表明，在诱导化疗结束和放疗开始之间的时间间隔内，由于肿瘤细胞增殖加速，肿瘤进展迅速：肿瘤平均倍增时间远短于未治疗的肿瘤。因此，诱导化疗在体积减少方面获得的收益在等待放射治疗的时间中损失了。我们建议尽量缩短化疗和放疗之间的时间间隔。
Induction chemotherapy of non-small-cell lung cancer (NSCLC) stage III with gemcitabine and cisplatin for downstaging of the tumour with the aim for further treatment with ionising radiation is one of the treatments for lung cancer patients. The purpose of this study was to investigate the influence of the waiting time for radiotherapy, that is, the interval between induction chemotherapy and radiotherapy, on the rate of tumour growth for patients with NSCLC. Interval times between the end of induction chemotherapy and date of diagnostic CT, planning CT and first day of radiotherapy were determined for 23 patients with NSCLC. Increase in gross tumour volume was measured for 18 patients by measuring the dimensions of the primary tumour and lymph node metastases on the diagnostic CT after induction chemotherapy and on the CT used for radiotherapy planning. For each patient, the volume doubling time was calculated from the time interval between the two CTs and ratio of the gross volumes on planning CT and diagnostic CT. The mean time interval between end of chemotherapy and day of diagnostic CT was 16 days, and till first day of radiotherapy 80.3 (range 29 – 141) days. In all, 41% of potentially curable patients became incurable in the waiting period. The ratio of gross tumour volumes of the two CTs ranged from 1.1 to 81.8 and the tumour doubling times ranged from 8.3 to 171 days, with a mean value of 46 days and median value of 29 days. This is far less than the mean doubling time of NSCLC in untreated patients found in the literature. This study shows that in the time interval between the end of induction chemotherapy and the start of radiotherapy rapid tumour progression occurs as a result of accelerated tumour cell proliferation: mean tumour doubling times are much shorter than those in not treated tumours. As a consequence, the gain obtained with induction chemotherapy with regard to volume reduction was lost in the waiting time for radiotherapy. We recommend diminishing the time interval between chemo- and radiotherapy to as short as possible.