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Twice Daily Radiation Therapy Plus Concurrent Chemotherapy for Limited-Stage Small Cell Lung Cancer
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Á¶¹®ÁØ/±è¼±¿µ/±è±âȯ/±èÁØ»ó/Cho MJ/Kim SY/Kim KW/Kim JS
KMID : 0859320060240020096
Abstract
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´ë»ó ¹× ¹æ¹ý: 1993³â 2¿ùºÎÅÍ 2002³â 10¿ù±îÁö ÃÑ 76¸íÀÇ È¯ÀÚ°¡ Á¶Á÷ÇÐÀûÀ¸·Î Áõ¸íµÈ ±¹ÇѼºº´±â ¼Ò¼¼Æ÷ Æó¾ÏÀ¸·Î ÇÏ·ç µÎ ¹ø ºÐÇÒÁ¶»ç¿¡ ÀÇÇÑ µ¿½Ã ÈÇйæ»ç¼±Ä¡·á¸¦ ½ÃÇà ¹Þ¾Ò´Ù. ´ë»óȯÀÚ Áß ³²¼ºÀº 84% (64/76)À̾ú°í, Áß¾Ó¿¬·ÉÀº 57¼¼¿´´Ù(32¡75¼¼). ÈäºÎ¹æ»ç¼±Ä¡·á´Â 120 ¶Ç´Â 150 cGy/fraction·Î ÃÖ¼Ò 6½Ã°£ÀÇ °£°ÝÀ» µÎ°í ÇÏ·ç µÎ ¹ø, ÇÑ ÁÖ¿¡ 5ÀÏ ½ÃÇàÇÏ¿´´Ù. ÃÑ ÈäºÎÁ¶»ç¼±·®ÀÇ Áß¾Ó°ªÀº 50.4 Gy¿´´Ù(45¡51 Gy). µ¿½Ã ÈÇÐ Ä¡·áÀº 3ÁÖ °£°ÝÀ¸·Î ±³´ë CAV (cytoxan 1,000 mg/m2, adriamycin 40 mg/m2, vincristine 1 mg/m2)/PE (cisplatin 60 mg/m2, etoposide 100 mg/m2)À̰ųª, ȤÀº ´Üµ¶ PE ¿ä¹ýÀÌ »ç¿ëµÇ¾ú´Ù. ÈÇÐÄ¡·á Ƚ¼öÀÇ Áß¾Ó°ªÀº 6ȸ¿´´Ù(1¡9ȸ). ¿¹¹æÀû Àü³úÁ¶»ç´Â ¿ÏÀü°üÇظ¦ º¸ÀΠȯÀÚ¿¡°Ô 25 Gy/10 fractions·Î ½ÃÇàµÇ¾ú´Ù. Áß¾ÓÃßÀû°üÂû±â°£Àº 18°³¿ùÀ̾ú´Ù(1¡136°³¿ù).
°á °ú: Ä¡·áÀÇ ¹ÝÀÀ·üÀº 86%À̾ú´Ù; ¿ÏÀü°üÇØ°¡ 39¸í(52%), ºÎºÐ°üÇØ°¡ 26¸í(34%)À̾ú´Ù. Áß¾Ó»ýÁ¸±â°£Àº 23°³¿ùÀ̾ú´Ù. 1³â, 2³â, 3³â »ýÁ¸À²Àº °¢°¢ 72%, 50%, 30%À̾ú´Ù. ´Üº¯·®ºÐ¼®¿¡¼ Ä¡·á ¹ÝÀÀ·üÀÌ »ýÁ¸À²ÀÇ À¯ÀÇÇÑ ¿¹ÈÄÀÎÀÚ·Î ¹àÇôÁ³´Ù(p£¼0.001). µî±Þ 3 ÀÌ»óÀÇ ±Þ¼ººÎÀÛ¿ëÀº ¹éÇ÷±¸°¨¼Ò 46¸í(61%), ÀûÇ÷±¸ °¨¼Ò 5¸í(6%), Ç÷¼ÒÆÇ °¨¼Ò 10¸í(13%), ½Äµµ¿° 5¸í(6%), ±×¸®°í Æ󵶼ºÀÌ 2¸í(2%)¿¡¼ ÀÖ¾ú´Ù. Ãßô°üÂûÀÌ °¡´ÉÇß´ø 73¸íÀÇ È¯ÀÚ Áß ÃÑ 38¸í(52%)¿¡¼ º´ÀÇ ÁøÇàÀÌ °üÂûµÇ¾ú´Ù. ù ¹ø° ¿ø°ÝÀüÀÌ Àå¼ÒÀÇ ºóµµ´Â ³ú°¡ °¡Àå ³ô¾Ò´Ù.
°á ·Ð: ÇÏ·ç µÎ ¹ø ºÐÇÒÁ¶»ç¿¡ ÀÇÇÑ µ¿½Ã ÈÇйæ»ç¼±Ä¡·á´Â ±¹ÇѼºº´±â ¼Ò¼¼Æ÷Æó¾Ï ȯÀÚ¿¡¼ ³ª»ÚÁö ¾ÊÀº ºÎÀÛ¿ë°ú ÇÔ²² ¾çÈ£ÇÑ Ä¡·á¹ÝÀÀ ¹× »ýÁ¸À²ÀÇ °á°ú¸¦ º¸¿´´Ù. »ýÁ¸À²ÀÇ À¯ÀÇÇÑ ¿¹ÈÄÀÎÀÚ·Î ¹àÇôÁø Ä¡·á ¹ÝÀÀ·üÀ» Çâ»ó½ÃÅ°±â À§ÇØ ¹æ»ç¼±Ä¡·á ºÐÇÒ¹æ½Ä, ÈÇпä¹ýÁ¦Á¦, ÈÇйæ»ç¼±Ä¡·áÀÇ °áÇÕ¹æ½Ä¿¡ ´ëÇÑ Ãß°¡ÀûÀÎ ¿¬±¸°¡ ÇÊ¿äÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù.
Purpose: A retrospective study was performed to evaluate the efficiency and feasibility of twice daily radiation therapy plus concurrent chemotherapy for limited-stage small cell lung cancer in terms of treatment response, survival, patterns of failure, and acute toxicities.
Materials and Methods: Between February 1993 and October 2002, 76 patients of histologically proven limited-stage small cell lung cancer (LS-SCLC) were treated with twice daily radiation therapy and concurrent chemotherapy. Male was in 84% (64/76), and median age was 57 years (range, 32¡75 years). Thoracic radiation therapy consisted of 120 or 150 cGy per fraction, twice a day at least 6 hours apart, 5 days a week. Median total dose was 50.4 Gy (range, 45¡51 Gy). Concurrent chemotherapy consisted of CAV (cytoxan 1000 mg/m2, adriamycin 40 mg/m2, vincristine 1 mg/m2) alternating with PE (cisplatin 60 mg/m2, etoposide 100 mg/m2) or PE alone, every 3 weeks. The median cycle of chemotherapy was six (range, 1¡9 cycle). Prophylactic cranial irradiation (PCI) was recommended to the patients who achieved a complete response (CR). PCI scheme was 25 Gy/ 10 fractions. Median follow up was 18 months (range, 1¡136 months).
Results: Overall response rate was 86%; complete response in 39 (52%) and partial response in 26 (34%) patients. The median overall survival was 23 months. One, two, and three year overall survival rate was 72%, 50% and 30%, respectively. In univariate analysis, the treatment response was revealed as a significant favorable prognostic factor for survival (p£¼0.001). Grade 3 or worse acute toxicities were leukopenia in 46 (61%), anemia in 5 (6%), thrombocytopenia in 10 (13%), esophagitis in 5 (6%), and pulmonary toxicity in 2 (2%) patients. Of 73 evaluable patients, 40 (55%) patients subsequently had disease progression. The most frequent first site of distant metastasis was brain.
Conclusion: Twice daily radiation therapy plus concurrent chemotherapy produced favorable response and survival for LS-SCLC patients with tolerable toxicities. To improve the treatment response, which proved as a significant prognostic factor for survival, there should be further investigations about fractionation scheme, chemotherapy regimens and compatible chemoradiotherapy schedule.
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