EP方案序貫IP方案一線治療廣泛期小細(xì)胞肺癌的臨床對(duì)比分析
發(fā)布時(shí)間：2018-12-15 17:14
【摘要】：小細(xì)胞肺癌(small-cell lung cancer,SCLC)占所有肺癌的20%-25%,新發(fā)病例中60%-70%是廣泛期疾病。SCLC惡性程度高,轉(zhuǎn)移早而廣泛,大部分患者出現(xiàn)血行轉(zhuǎn)移,僅1/3患者病變局限于胸腔。SCLC對(duì)化療、放療高度敏感,初治緩解率高,但極易發(fā)生繼發(fā)性耐藥,最終死于腫瘤復(fù)發(fā)。目前SCLC仍以全身化療為主要治療手段,自20世紀(jì)80年代以來(lái),EP(依托泊苷聯(lián)合順鉑)化療方案逐漸取代CAV(環(huán)磷酰胺+阿霉素+長(zhǎng)春新堿)方案,并因其生存優(yōu)勢(shì)最終成為小細(xì)胞肺癌的一線標(biāo)準(zhǔn)治療方案。EP方案的客觀緩解率為60%-70%,中位總生存時(shí)間為9-11個(gè)月,2年生存率5%。多數(shù)患者在化療停止6個(gè)月內(nèi)疾病發(fā)生進(jìn)展,為此如何提高SCLC的治療有效率,延長(zhǎng)患者的生存時(shí)間,減少耐藥性成為臨床研究的熱點(diǎn)。本文對(duì)EP方案穩(wěn)定者進(jìn)行序貫化療的治療效果進(jìn)行分析對(duì)比,旨在探索改善廣泛期SCLC預(yù)后的有效方法。研究目的:研究廣泛期小細(xì)胞肺癌(ED-SCLC)的一線治療,依托泊苷聯(lián)合順鉑(EP)方案序貫伊立替康聯(lián)合順鉑(IP)方案在疾病穩(wěn)定患者中的療效以及不良反應(yīng)的發(fā)生情況。方法:回顧性分析55例初治ED-SCLC患者的臨床病例資料,所有的患者均應(yīng)用EP方案化療2個(gè)周期,而且療效評(píng)估穩(wěn)定。根據(jù)治療方法的不同將所有患者分為兩組,其中序貫應(yīng)用IP方案者25例EP+IP方案組,繼續(xù)應(yīng)用EP方案者30例EP方案組,所有的患者均完成至少4個(gè)周期的化療,每個(gè)周期評(píng)價(jià)不良反應(yīng),每2個(gè)周期評(píng)價(jià)療效,并且對(duì)兩組患者的治療效果及不良反應(yīng)的發(fā)生情況進(jìn)行對(duì)比分析。結(jié)果:共55例初治ED-SCLC患者,EP+IP方案組25例CR 0例,PR 17例,SD 6例,PD 2例,ORR為68.0%,中位FPS為7.0個(gè)月,OS為16.0個(gè)月;EP方案組30例CR 0例,PR 8例,SD 17例,PD 5例,ORR為26.7%,中位FPS為5.0個(gè)月,OS為12.0個(gè)月,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者的不良反應(yīng)主要是血液學(xué)和消化道的不良反應(yīng),EP+IP方案組的白細(xì)胞減少、血小板減少的發(fā)生率低于EP方案組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);而EP+IP方案組的遲發(fā)性腹瀉發(fā)生率高于EP方案組,但是大多為Ⅰ~Ⅱ度,患者均可以耐受,沒(méi)有化療相關(guān)性死亡。結(jié)論:1、初治ED-SCLC,應(yīng)用EP方案一線治療2個(gè)周期,療效評(píng)估穩(wěn)定的患者,序貫IP方案優(yōu)于繼續(xù)應(yīng)用EP方案。2、EP方案序貫應(yīng)用IP方案可以提高ORR,延長(zhǎng)PFS和OS。3、安全性方面,兩組患者不良反應(yīng)主要為血液學(xué)和消化道不良反應(yīng),均可耐受,無(wú)化療相關(guān)性死亡。
[Abstract]:Small cell lung cancer (small-cell lung cancer,SCLC) accounts for 20-25% of all lung cancers, and 60% -70% of the new cases are extensive diseases. SCLC has a high degree of malignancy, and metastasis is early and widespread. Most of the patients have blood metastases. Only one third of the patients were confined to the chest cavity. SCLC was highly sensitive to chemotherapy, highly sensitive to radiotherapy, and had a high initial remission rate, but it was prone to secondary drug resistance and eventually died of tumor recurrence. At present, SCLC still uses systemic chemotherapy as the main treatment method. Since 1980s, EP (etoposide combined with cisplatin has gradually replaced CAV (cyclophosphamide adriamycin vincristine) regimen. The objective remission rate of EP regimen was 60-70, the median survival time was 9-11 months, and the 2-year survival rate was 5. Most patients develop within 6 months after chemotherapy, so how to improve the effective rate of SCLC, prolong the survival time of patients and reduce drug resistance has become the focus of clinical research. The effect of sequential chemotherapy on patients with stable EP regimen was analyzed and compared in order to explore an effective method to improve the prognosis of extensive SCLC. Objective: to study the efficacy and adverse effects of etoposide combined with cisplatin (EP) regimen in the treatment of extensive small cell lung cancer (ED-SCLC) in patients with stable disease. Methods: the clinical data of 55 patients with ED-SCLC were analyzed retrospectively. All patients were treated with EP regimen for 2 cycles, and the curative effect was evaluated stably. All patients were divided into two groups according to different treatment methods, including 25 cases of EP IP regimen with sequential IP regimen and 30 cases with EP regimen. All patients completed at least 4 cycles of chemotherapy. Adverse reactions were evaluated in each cycle and curative effects were evaluated every 2 cycles. The therapeutic effects and adverse reactions in the two groups were compared and analyzed. Results: there were 25 cases of CR, 17 cases of PR, 6 cases of SD, 2 cases of PD, 68.0 months of ORR, 7.0 months of FPS and 16.0 months of OS. In EP group, 30 cases of CR, 8 cases of PR, 17 cases of SD, 5 cases of PD, ORR were 26.7 months, median FPS was 5.0 months, OS was 12.0 months, the difference was statistically significant (P0.05). The adverse reactions of the two groups were mainly hematological and gastrointestinal adverse reactions: leukopenia and thrombocytopenia in, EP IP group were lower than those in EP group (P0.05). However, the incidence of delayed diarrhea in EP IP group was higher than that in EP group, but most of them were 鈪，
本文編號(hào)：2381013
[Abstract]:Small cell lung cancer (small-cell lung cancer,SCLC) accounts for 20-25% of all lung cancers, and 60% -70% of the new cases are extensive diseases. SCLC has a high degree of malignancy, and metastasis is early and widespread. Most of the patients have blood metastases. Only one third of the patients were confined to the chest cavity. SCLC was highly sensitive to chemotherapy, highly sensitive to radiotherapy, and had a high initial remission rate, but it was prone to secondary drug resistance and eventually died of tumor recurrence. At present, SCLC still uses systemic chemotherapy as the main treatment method. Since 1980s, EP (etoposide combined with cisplatin has gradually replaced CAV (cyclophosphamide adriamycin vincristine) regimen. The objective remission rate of EP regimen was 60-70, the median survival time was 9-11 months, and the 2-year survival rate was 5. Most patients develop within 6 months after chemotherapy, so how to improve the effective rate of SCLC, prolong the survival time of patients and reduce drug resistance has become the focus of clinical research. The effect of sequential chemotherapy on patients with stable EP regimen was analyzed and compared in order to explore an effective method to improve the prognosis of extensive SCLC. Objective: to study the efficacy and adverse effects of etoposide combined with cisplatin (EP) regimen in the treatment of extensive small cell lung cancer (ED-SCLC) in patients with stable disease. Methods: the clinical data of 55 patients with ED-SCLC were analyzed retrospectively. All patients were treated with EP regimen for 2 cycles, and the curative effect was evaluated stably. All patients were divided into two groups according to different treatment methods, including 25 cases of EP IP regimen with sequential IP regimen and 30 cases with EP regimen. All patients completed at least 4 cycles of chemotherapy. Adverse reactions were evaluated in each cycle and curative effects were evaluated every 2 cycles. The therapeutic effects and adverse reactions in the two groups were compared and analyzed. Results: there were 25 cases of CR, 17 cases of PR, 6 cases of SD, 2 cases of PD, 68.0 months of ORR, 7.0 months of FPS and 16.0 months of OS. In EP group, 30 cases of CR, 8 cases of PR, 17 cases of SD, 5 cases of PD, ORR were 26.7 months, median FPS was 5.0 months, OS was 12.0 months, the difference was statistically significant (P0.05). The adverse reactions of the two groups were mainly hematological and gastrointestinal adverse reactions: leukopenia and thrombocytopenia in, EP IP group were lower than those in EP group (P0.05). However, the incidence of delayed diarrhea in EP IP group was higher than that in EP group, but most of them were 鈪，
本文編號(hào)：2381013
本文鏈接：http://sikaile.net/yixuelunwen/zlx/2381013.html
最近更新
教材專著
