The importance of surgical and multimodality treatment for small cell bronchial carcinoma.
The importance of surgical and multimodality treatment for small cell bronchial carcinoma.
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手术和多学科治疗对小细胞支气管癌的重要性。
DOI：
10.1016/s0022-5223(19)35321-8
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
G. Salzer
中科院分区：
文献类型：
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作者：
K. Karrer;T. Shields;H. Denck;B. Hrabar;I. Vogt‐Moykopf;G. Salzer
在一项合作的国际肺癌多模式治疗试验中，112名小细胞肺癌患者接受了最初的手术切除，然后随机接受两种术后强化化疗方案中的一种，然后对没有疾病的患者进行预防性头颅照射。方案A包括8个疗程的环磷酰胺、阿霉素和长春新碱，方案B包括两个疗程的三个序贯药物组合：(1)环磷酰胺、洛莫司汀和甲氨蝶呤；(2)环磷酰胺、阿霉素和长春新碱；(3)异环磷酰胺和依托泊苷。47例患者术前已确诊，65例直到切除标本检查后才确诊(所有诊断均由裁判病理学家复查)。每例患者根据病理TNM特点进行分类。其中I期38例，II期39例，IIIa期35例。IIIa期，T3N0-1期9例，T1-3N2期26例(多数N2期直到开胸手术前临床未发现或仅通过切除的纵隔淋巴结常规组织学检查才能发现)。用寿命表法计算24个月的早期存活率：I期76%，II期56%，IIIa期49%(T3 N0-1，89%；TL-3 N 2，35%)。36个月的存活率分别为62%、50%和41%(74%和29%)。43例N0疾病患者的预计36个月存活率为65%；43例N1疾病患者的预计36个月存活率为52%；26例N2疾病患者的预计36个月存活率为29%。两个化疗组的存活率都没有发现差异。结论：对局限性小细胞癌(I期、II期和T3N0-1期)，早期手术切除，然后强化化疗是一种合适的治疗方法。对于T1-3N2病，结果是不确定的。
In a cooperative international lung cancer multimodality treatment trial, 112 patients with small cell lung cancer underwent initial surgical resection and were then randomized to receive one of two intensive postoperative chemotherapeutic regimens, followed by prophylactic cranial irradiation in the disease-free patients. Regimen A consisted of eight courses of cyclophosphamide, doxorubicin, and vincristine and regimen B of two courses of three sequential drug combinations: (1) cyclophosphamide, lomustine, and methotrexate; (2) cyclophosphamide, doxorubicin, and vincristine; and (3) ifosfamid and etoposide. In 47 patients the diagnosis was known preoperatively and in 65 it was not confirmed until the resected specimen was examined (all diagnoses were reviewed by a referee pathologist). Each patient was classified by the pathologic TNM characteristics. There were 38 patients with stage I disease, 39 patients with stage II, and 35 patients with stage IIIa disease. In stage IIIa there were nine patients with T3 N0–1 disease and 26 with T1–3 N2 disease (most N2 disease was clinically undetected until thoracotomy or was discovered only by routine histologic examination of the resected mediastinal nodes). Early survival rates at 24 months calculated by the life table method are as follows: stage I, 76%; stage II, 56%; and stage IIIa, 49% (T3 N0–1,89%; Tl-3 N2, 35%). Survival rates at 36 months are 62%, 50%, and 41% (74% and 29%), respectively. The projected 36-month survival rate for 43 patients with N0 disease is 65%; for 43 with N1 disease, 52%; and for 26 with N2 disease, 29%. No difference in survival has been noted in either chemotherapy treatment group. It is concluded that initial surgical resection for limited small cell cancer (stage I, II, and T3 N0–1) followed by intensive chemotherapy is an appropriate therapeutic approach. For T1–3 N2 disease the results are inconclusive.