Treatment Results of Chemotherapy and Radiotherapy in Limited-Stage Small Cell Lung Cancer

小細胞肺癌接受化學治療與放射治療之治療結果

黃家後(Chia-Chun Huang) ； 劉慕台(Mu-Tai Liu) ； 畢祖平(Chu-Ping Pi) ； 張東浩(Tung-Hao Chang) ； 王愛義(Ai-Yih Wang) ； 黃昭源(Chao-Yuan Huang)

《放射治療與腫瘤學》 12卷1期 (2005/03) Pp. 27-37

https://doi.org/10.6316/TRO/200512(1)27

摘要

目的：本文旨在研究侷限期小細胞肺癌病人接受化學治療與放射治療的治療結果，並分析影響治療結果的預後因子。
材料與方法：自1997年1月至2003年9月，共有27位病人在彰化基督教醫院診斷為侷限期小細胞肺癌，並接受化學治療與放射治療。其中22位(82%)是男性，5位(18%)是女性。診斷年齡中位數是61歲。根據ECOG (Eastern Cooperative Oncology Group) performance status狀態來評分，3位病人(11%)是ECOG 0，20位(74%)是ECOG 1，4位(15%)是ECOG 2。治療方針包括了同步化學放射治療(CCRT)或者是化學治療之後再接受放射治療。化學治療的藥物是cisplatin與etoposide，放射治療的劑量中位數是55.80 Gy。
結果：15位病人(55%)腫瘤達到完全緩解，4位病人(15%)達到部分緩解，整體緩解率是70%。在15位腫瘤達到完全緩解的病人當中，只有一位病人(7%)有局部復發的情形。在遠端轉移方面，有13位病人(48%)有遠端轉移，在他們當中有9位(69%)最後死亡。所有27位病人的平均存活時間是28個月。在存活率方面，1年、2年與5年的整體存活率分別是67%、54%與43%。1年、2年與5年的無病存活率分別是68%、36%與22%。1年、2年與5年的疾病相關存活率分別是67%、58%與465。在預後因子分析方面，放射治療總劑量(p=0.018)是影響腫瘤緩解的重要因子。體重是否減輕(p=0.010)、化學治療的次數(0.007)以及腫瘤是否有緩解(p=0.032)則是影響整體存活率的預後因子。體重是否減輕(p=0.037)、化學治療的次數(0.001)以及是否有遠端轉移(p=0.001)是影響無病存活率的預後因子。體重是否減輕(p=0.004)、化學治療的次數(0.030)以及腫瘤是否有緩解(p=0.050)則是影響疾病相關存活率的預後因子。
結論：使用cisplatin與etoposide的化學治療併放射治療，對於侷限期的小細胞肺癌病人來說是一個可行的治療方式。可以達到70%的腫瘤緩解率，2年的整體存活率則為54%。然而，遠端轉移仍舊是影響存活率的關鍵。在15位最後死亡的病人當中，有9位(60%)就是因為遠端轉移而死亡。未來應該有更大型的研究針對侷限期的小細胞肺癌來探討新的化學治療藥物與放射治療技術，以期研擬出最適合的治療方式並達到令人滿意的治療結果。

關鍵字

小細胞肺癌 ； 侷限期 ； 化學治療 ； 放射治療

並列摘要

Purpose: The purpose of our study was to evaluate the treatment results and to analyze the prognostic factors affecting the outcome of limited-stage small cell lung cancer patients treated with combined chemotherapy and radiotherapy.
Materials and Methods: From January 1997 through September 2003, there were 27 patients diagnosed as limited-stage small cell lung cancer in Changhua Christian Hospital, Taiwan. Among the 27 patients treated with chemotherapy and radiotherapy, 22 (82%) were male and 5 (18%) were female. The median age of diagnosis was 61 years. According to the ECOG (Eastern Cooperative Oncology Group) performance status scaling system, 3 patients (11%) were ECOG 0, 20 patients (74%) were ECOG 1, and 4 patients (15%) were ECOG 2. The treatments consisted of either concurrent chemoradiotherapy (CCRT) or chemotherapy followed by radiotherapy. Chemotherapy regimens were cisplatin and etoposide. The median thoracic irradiation dose was 55.8 Gy (range: 45-64.8 Gy).
Results: There were 15 patients (55%) achieving complete response, and 4 patients (15%) having partial response, with a total local response rate of 70%. Only one patient (7%) had local relapse out of 15 patients with complete tumor response. A total of 14 patients achieved local regional control (52%, 14 out of total 27 patients). Thirteen patients (48%) had distant metastasis, and 9 patients (69%) died of their diseases during the follow-up periods. The mean survival time was 28 months. In survival analysis, the 1- year, 2-year and 5-year overall survival rates were 67%, 54% and 43%, respectively. The 1-year, 2-year and 5-year disease-free survival rates were 68%, 36% and 22%, respectively. The 1-year, 2-year and 5-year disease-specific survival rates were 67%, 58% and 46%, respectively. In prognostic factors analysis, cumulative irradiation dose (p=0.018) was a predictor for local response. Body weight loss (p=0.010), cycles of chemotherapy (p=0.007) and local response (p=0.032) were prognostic factors for overall survival. Body weight loss (p=0.037), cycles of chemotherapy (p=0.001) and distant metastasis (p=0.001) were prognostic factors for disease-free survival. Body weight loss (p=0.004), cycles of chemotherapy (p=0.030) and local response (p=0.050) were prognostic factors for disease-specific survival.
Conclusion: Chemotherapy of cisplatin and etoposide combined with radiotherapy is a feasible treatment modality for patients of limited-stage small cell lung cancer. A local response rate of 70%, and a 2-year overall survival of 54% were achieved. However, distant failure is still the major concern affecting survival in our present study. Among the 15 patients died of their diseases, 9 patients (60%) were dead due to distant metastasis. The modifications of chemotherapy regimens and radiotherapy techniques in further clinical trials are warranted to explore an optimal treatment and to achieve a satisfactory out- come for limited-stage small cell lung cancer.

並列關鍵字

Small cell lung cancer ； Limited stage ； Chemotherapy ； Radiotherapy