Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide
Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide
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DOI：
10.1056/nejm199901283400403
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发表时间：
1999-01-28
影响因子：
158.5
通讯作者：
Johnson, DH
中科院分区：
文献类型：
--
作者：
Turrisi, AT;Kim, K;Johnson, DH
背景对于局限于单侧半胸的小细胞肺癌（局限性小细胞肺癌），胸部放疗可提高生存率，但化疗与胸部放疗结合的最佳方式仍未确定。每日两次的胸部加速放疗比每日一次的放疗有潜在的优势。方法对417例局限性小细胞肺癌患者进行研究。所有患者均接受4个21天周期的顺铂加依托泊苷治疗。我们随机分配这些患者接受总共45 Gy的同步胸部放疗，在三周内每天两次或在五周内每天一次。结果与同期每日一次放疗相比，从第一个化疗周期开始每日两次治疗可显著提高生存率（log-rank检验P = 0.04）。经过近8年的中位随访，每日一次组的中位生存期为19个月，每日两次组的中位生存期为23个月。每天接受一次放射治疗的患者，两年生存率为41%，五年生存率为16%。对于每天接受两次放射治疗的患者，两年生存率为47%，五年生存率为26%。3级食管炎在每日两次的胸部放疗组中更为常见，发生率为27%，而每日一次放疗组为11% （P < 0.001）。结论：从第1周期化疗开始，顺铂加依托泊苷4个周期和一个疗程的放疗（45 Gy，每日1次或2次）可使有限小细胞肺癌患者的2年和5年总体生存率分别为44%和23%，与之前的结果相比，生存率有相当大的提高。[J] .中华医学杂志1999；34(4):344 - 349。(C) 1999年，马萨诸塞州医学协会。
Background For small-cell lung cancer confined to one hemithorax (limited small-cell lung cancer), thoracic radiotherapy improves survival, but the best ways of integrating chemotherapy and thoracic radiotherapy remain unsettled. Twice-daily accelerated thoracic radiotherapy has potential advantages over once-daily radiotherapy.Methods We studied 417 patients with limited small-cell lung cancer. All the patients received four 21-day cycles of cisplatin plus etoposide. We randomly assigned these patients to receive a total of 45 Gy of concurrent thoracic radiotherapy, given either twice daily over a three-week period or once daily over a period of five weeks.Results Twice-daily treatment beginning with the first cycle of chemotherapy significantly improved survival as compared with concurrent once-daily radiotherapy (P = 0.04 by the log-rank test). After a median follow-up of almost 8 years, the median survival was 19 months for the once-daily group and 23 months for the twice-daily group. The survival rates for patients receiving once-daily radiotherapy were 41 percent at two years and 16 percent at five years. For patients receiving twice-daily radiotherapy, the survival rates were 47 percent at two years and 26 percent at five years. Grade 3 esophagitis was significantly more frequent with twice-daily thoracic radiotherapy, occurring in 27 percent of patients, as compared with 11 percent in the once-daily group (P < 0.001).Conclusions Four cycles of cisplatin plus etoposide and a course of radiotherapy (45 Gy, given either once or twice daily) beginning with cycle 1 of the chemotherapy resulted in overall two- and five-year survival rates of 44 percent and 23 percent, a considerable improvement in survival rates over previous results in patients with limited small-cell lung cancer. (N Engl J Med 1999;340:265-71.) (C) 1999, Massachusetts Medical Society.