Combination chemotherapy for small cell carcinoma of the lung: continuous versus alternating non-cross-resistant combinations.
Combination chemotherapy for small cell carcinoma of the lung: continuous versus alternating non-cross-resistant combinations.
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小细胞肺癌的联合化疗：连续与交替非交叉耐药组合。
DOI：
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发表时间：
1982
期刊：
影响因子：
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通讯作者：
P. Wiernik
中科院分区：
文献类型：
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作者：
J. Aisner;M. Whitacre;Van Echo Da;P. Wiernik
在对小细胞肺癌程度进行分层后，109例患者随机接受环磷酰胺、阿霉素和VP-16-213化疗周期[CAVP16（方案一）]，或接受CAVP16治疗至最大疗效（至少3个疗程），然后用CCNU、甲氨蝶呤、长春新碱和丙卡嗪（COMP）与CAVP16交替化疗（方案二）。一组完全缓解的患者被随机分为全脑照射组和仅观察组。在44例有限疾病患者中，28例（64%）达到完全缓解，11例（26%）达到部分缓解。在65例广泛性疾病患者中，26例（40%）获得完全缓解，28例（46%）获得部分缓解。两种治疗方案在反应或生存方面没有显著差异。局限性和广泛性疾病的预计中位生存时间分别为14个月和10个月。近30%的有限疾病患者将是2年无病幸存者。29例患者随机接受颅脑照射或仅观察；15例放疗患者均未发生脑转移，但14例随机观察患者中有5例脑复发（P = 0.02）。一名患者死于尸检证据仅颅内疾病。主要的血液学毒性作用是白细胞减少。中性粒细胞减少期间有31次发热（21次感染）和4次中毒性死亡。非血液学毒性轻微。在达到完全缓解的患者中，颅照射可延迟或减少中枢神经系统转移的发生率。虽然交替化疗没有益处，但单独联合化疗与CAVP16是小细胞非常有效的治疗方式。
After stratification for extent of small cell lung cancer, 109 patients were randomized to receive cycles of chemotherapy with cyclophosphamide, doxorubicin, and VP-16-213 [CAVP16 (regimen I)] or to receive CAVP16 to maximum response (minimum of three courses) and then chemotherapy with CCNU, methotrexate, vincristine, and procarbazine (COMP) alternating with CAVP16 (regimen II). A group of patients who achieved complete remission were randomized to receive whole-brain irradiation or to have observation only. Of the 44 patients with limited disease, 28 (64%) achieved a complete remission and 11 (26%) achieved a partial remission. Of the 65 patients with extensive disease, 26 (40%) achieved a complete remission and 28 (46%) achieved a partial remission. There were no significant differences between the regimens in response or survival. The projected median survival times are 14 and 10 months for limited and extensive disease, respectively. Nearly 30% of patients with limited disease will be 2-year, disease-free survivors. Twenty-nine patients were randomized to receive cranial irradiation or observation only; none of the 15 irradiated patients developed cerebral metastases, but five of 14 randomized to observation relapsed in the brain (P = 0.02). One patient died with necropsy evidence of only intracranial disease. The principal hematologic toxic effect was leukopenia. There were 31 febrile episodes (21 infectious) during neutropenia and four toxic deaths. Nonhematologic toxicity was mild. Cranial irradiation in patients who achieve complete remission delays or reduces the incidence of CNS metastases. Although alternating chemotherapy is not beneficial, combination chemotherapy with CAVP16 alone is highly effective treatment modality for small cell.