Induction chemotherapy followed by chemoradiotherapy compared with chemoradiotherapy alone for regionally advanced unresectable stage III non-small-cell lung cancer: Cancer and Leukemia Group B
Induction chemotherapy followed by chemoradiotherapy compared with chemoradiotherapy alone for regionally advanced unresectable stage III non-small-cell lung cancer: Cancer and Leukemia Group B
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DOI：
10.1200/jco.2006.07.3569
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发表时间：
2007-05-01
影响因子：
45.3
通讯作者：
Green, Mark R.
中科院分区：
文献类型：
--
作者：
Vokes, Everett E.;Herndon, James E., II;Green, Mark R.
不能切除的III期非小细胞肺癌的标准治疗包括同步放化疗。在癌症和白血病组B 39801中，我们评估了在同步放化疗之前的诱导化疗是否会导致生存率的提高。其中包括立即同步放化疗，卡铂浓度-时间曲线下面积（AUC）为2，紫杉醇50 mg/m2（2）在66戈伊胸部放疗期间每周给药一次，或B组，包括两个周期的卡铂AUC 6和紫杉醇200 mg/m2，每21天给药一次，随后进行相同的放化疗。应计目标是360 patients.Results34%的患者为女性，66%为男性，中位年龄为63岁。B组诱导化疗期间的3级或4级毒性主要包括中性粒细胞减少（分别为18%和20%）。在同步放化疗期间，食管炎（3级和4级分别为30%和2%，A组v 28%和8%，B组）和呼吸困难（3级和4级分别为11%和3%，A组v 15%和4%，B组）的现场毒性严重程度无差异。生存期差异无统计学意义（P = 0.3），A组的中位生存期为12个月（95% CI，10 - 16个月），而B组为14个月（95% CI，11 - 16个月），2年生存率为29%（95% CI，22%-35%）和31%（95% CI，25%-38%）。年龄，治疗前的体重减轻，和性能状态是统计学上显着的预测factors.ConclusionThe除了诱导化疗同步放化疗增加毒性，并提供了同步放化疗没有生存的好处。每个治疗组的中位生存率都很低，每周常规使用卡铂和紫杉醇并同时进行放疗应重新检查。
PurposeStandard therapy for unresectable stage III non-small-cell lung cancer includes concomitant chemoradiotherapy. In Cancer and Leukemia Group B 39801, we evaluated whether induction chemotherapy before concurrent chemoradiotherapy would result in improved survival.Patients and MethodsBetween July 1998 and May 2002, 366 patients were randomly assigned to arm A, which involved immediate concurrent chemoradiotherapy with carboplatin area under the concentration-time curve (AUC) of 2 and paclitaxel 50 mg/m(2) given weekly during 66 Gy of chest radiotherapy, or arm B, which involved two cycles of carboplatin AUC 6 and paclitaxel 200 mg/m(2) administered every 21 days followed by identical chemoradiotherapy. The accrual goal was 360 patients.ResultsThirty-four percent of patients were female, 66% were male, and the median age was 63 years. Grade 3 or 4 toxicities during induction chemotherapy on arm B consisted mainly of neutropenia (18% and 20%, respectively). During concurrent chemoradiotherapy, there was no difference in severity of in-field toxicities of esophagitis ( grade 3 and 4 were, respectively, 30% and 2% for arm A v 28% and 8% for arm B) and dyspnea ( grade 3 and 4 were, respectively, 11% and 3% for arm A v 15% and 4% for arm B). Survival differences were not statistically significant ( P =.3), with a median survival on arm A of 12 months (95% CI, 10 to 16 months) versus 14 months ( 95% CI, 11 to 16 months) on arm B and a 2-year survival of 29% ( 95% CI, 22% to 35%) and 31% ( 95% CI, 25% to 38%). Age, weight loss before therapy, and performance status were statistically significant predictive factors.ConclusionThe addition of induction chemotherapy to concurrent chemoradiotherapy added toxicity and provided no survival benefit over concurrent chemoradiotherapy alone. The median survival achieved in each of the treatment groups is low, and the routine use of weekly carboplatin and paclitaxel with simultaneous radiotherapy should be re-examined.