Kombinierte alternierende Chemo-Strahlentherapie beim kleinzelligen Bronchialkarzinom im Stadium III (TNM) (limited disease): Eine Phase-II-Studie mit Carboplatin/Etoposid/Vincristin und alternierender Strahlentherapie[1]

Zusammenfassung:

Hintergrund: Die kombinierte alternierende Chemo-Strahlentherapie des SCLC im Stadium III wird im Rahmen einer prospektiven Studie untersucht und im Rahmen der vorhandenen Literatur diskutiert. Methode: Geprüft wird ein alternierendes Regime von Chemotherapie (Carboplatin: AUC5, Etoposid: 3 × 120 mg/m², Vincristin: 2 mg d1, WH d 28) und Strahlentherapie (1 × 4 Gy/Woche) an 32 Patienten im Stadium IIIa und IIIb. Ergebnisse: Die kombinierte Strahlentherapie wird mit geringer Toxizität toleriert, wobei dosislimitierend die Hämatotoxizität war. Die Ergebnisse sind gut mit einem Response von 75 %, einem medianen Überleben von 14,5 Monaten und einem 2-Jahres-Überleben von 34 %. Zur Zeit werden 5 Langzeitüberlebende (über 29 Monate) beobachtet. Sowohl Lokal- als auch Fernrezidive treten in gleicher Häufigkeit (je 34 %) auf. Schlußfolgerungen: Die kombinierte Strahlen-Chemotherapie beim SCLC im Stadium III ist mit dem hier geprüften Regime gut praktikabel. Sie verspricht eine hohe Ansprechrate und ein günstiges 2-Jahres-Überleben. Lokal- und Fernrezidive treten in gleicher Häufigkeit auf und unterstreichen die Notwendigkeit sowohl einer besseren lokalen als auch systemischen Kontrolle.

Background: The combination of radio-chemotherapy is accepted standard in limited-disease small cell lung cancer, but the best way of combining the two modalities is still unknown. To test an alternating regime of early radiotherapy with hypofractionated radiotherapy we performed a phase II study in stage III small cell lung cancer. Method: 32 SCLC patients (n = 7 IIIa, n = 25 IIIb) were treated with a weekly alternating regime with either chemotherapy or radiotherapy. Chemotherapy included carboplatin (AUC5), etoposide (3 × 120 mg/m²) and vincristine (2 mg), repeated on day 28 for six cycles. Radiotherapy started one week before chemotherapy and was applied weekly 1 × 4 Gy, using a split-course regimen. Results: Combined radio-chemotherapy was well tolerated with dose-limiting hemotoxicity and very few cases of oesophagitis. Overall response was 75 %, median survival 14.5 months and the 2-year survival was 34.4 %. 5 patients are still living now for more than 29 months. Treatment failure was local and systemic in 34 % of the patients. Systemic failure included 6 patients with brain metastases. Conclusion: Combined radio-therapy in small-cell lung cancer using an alternating hypofractionated regimen is well tolerated. Response rate and 2-year survival are promising. Local and systemic failure is an ongoing problem and requires better local and systemic control of the disease.

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1 Teile dieser Arbeit wurden als Vortrag auf der Jahrestagung der DGP in Bad Reichenhall 1999 vorgestellt.