EFFECTS OF CONCOMITANT CISPLATIN AND RADIOTHERAPY ON INOPERABLE NON-SMALL-CELL LUNG-CANCER
EFFECTS OF CONCOMITANT CISPLATIN AND RADIOTHERAPY ON INOPERABLE NON-SMALL-CELL LUNG-CANCER
复制标题
DOI：
10.1056/nejm199202203260805
复制
发表时间：
1992-02-20
影响因子：
158.5
通讯作者：
BARTELINK, H
中科院分区：
文献类型：
--
作者：
SCHAAKEKONING, C;VANDENBOGAERT, W;BARTELINK, H
背景与方法。据报道，顺铂（顺二氨二氯铂）可增强放疗的细胞杀伤作用，其增强效果因给药方案而异。我们将331例无法手术的非转移性非小细胞肺癌患者随机分配到三种治疗方案中的一种：放疗两周（每周5次，每次3戈瑞，共10次），接着休息三周，然后再放疗两周（每周5次，每次2.5戈瑞，共10次）；按相同放疗方案，联合在每个治疗周的第一天给予每平方米体表面积30毫克顺铂；或者按相同放疗方案，联合在放疗前每天给予每平方米6毫克顺铂。
结果。与单纯放疗组相比，放疗联合每日顺铂组的生存率显著提高（P = 0.009）：放疗联合每日顺铂组1年生存率为54%，2年生存率为26%，3年生存率为16%，而单纯放疗组分别为46%、13%和2%。放疗联合每周顺铂组的生存率处于中间水平（1年44%，2年19%，3年13%），与其他两组中的任何一组生存率相比均无显著差异。每日联合治疗的生存获益是由于局部疾病控制得到改善（P = 0.003）。放疗联合每日顺铂组1年无局部复发生存率为59%，2年为31%；放疗联合每周顺铂组分别为42%和30%；单纯放疗组分别为41%和19%。每周给予顺铂的患者中有86%出现恶心和呕吐，每日给予顺铂的患者中有78%出现这些症状；其中分别有26%和28%的患者症状严重。
结论。对于非转移性但无法手术的非小细胞肺癌患者，每日给予顺铂并联合此处所述的放疗方案，可提高生存率和局部疾病控制率，但会产生严重的副作用。
Background and Methods. Cisplatin (cis-diamminedichloroplatinum) has been reported to enhance the cell-killing effect of radiation, an effect whose intensity varies with the schedule of administration. We randomly assigned 331 patients with nonmetastatic inoperable non-small-cell lung cancer to one of three treatments: radiotherapy for two weeks (3 Gy given 10 times, in five fractions a week), followed by a three-week rest period and then radiotherapy for two more weeks (2.5 Gy given 10 times, five fractions a week); radiotherapy on the same schedule, combined with 30 mg of cisplatin per square meter of body-surface area, given on the first day of each treatment week; or radiotherapy on the same schedule, combined with 6 mg of cisplatin per square meter, given daily before radiotherapy.Results. Survival was significantly improved in the radiotherapy-daily-cisplatin group as compared with the radiotherapy group (P = 0.009): survival in the radiotherapy-daily-cisplatin group was 54 percent at one year, 26 percent at two years, and 16 percent at three years, as compared with 46 percent, 13 percent, and 2 percent, respectively, in the radiotherapy group. Survival in the radiotherapy-weekly-cisplatin group was intermediate (44 percent, 19 percent, and 13 percent) and not significantly different from survival in either of the other two groups. The survival benefit of daily combined treatment was due to improved control of local disease (P = 0.003). Survival without local recurrence was 59 percent at one year and 31 percent at two years in the radiotherapy-daily-cisplatin group; 42 percent and 30 percent, respectively, in the radiotherapy-weekly-cisplatin group; and 41 percent and 19 percent, respectively, in the radiotherapy group. Cisplatin induced nausea and vomiting in 86 percent of the patients given it weekly and in 78 percent of those given it daily; these effects were severe in 26 percent and 28 percent, respectively.Conclusions. Cisplatin, given daily in combination with the radiotherapy described here to patients with nonmetastatic but inoperable non-small-cell lung cancer, improved rates of survival and control of local disease at the price of substantial side effects.