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以下内容来源于PubMed。
High-dose hyperfractionated simultaneous integrated boost radiotherapy versus standard-dose radiotherapy for limited-stage small-cell lung cancer in China: a multicentre, open-label, randomised, phase 3 trial
Abstract
Background: For the past 20 years, twice-daily thoracic radiotherapy with concurrent chemotherapy has been the treatment of choice for limited-stage small-cell lung cancer (LS-SCLC), which has a poor prognosis. We aimed to assess the efficacy and safety of high-dose, accelerated, hyperfractionated, twice-daily thoracic radiotherapy (54 Gy in 30 fractions) versus standard-dose radiotherapy (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC.
Methods: This open-label, randomised, phase 3 trial was performed at 16 public hospitals in China. The key inclusion criteria were patients aged 18-70 years, with histologically or cytologically confirmed LS-SCLC, who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and who were previously untreated or had received one course of cisplatin or carboplatin and etoposide. Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions to the gross tumour volume or VMAT with a simultaneous integrated boost of 54 Gy in 30 fractions to the gross tumour volume starting 0-42 days after the first chemotherapy course. Both groups received 10 fractions of twice-daily thoracic radiotherapy per week. The planning target volume was 45 Gy in 30 fractions in both groups. Patients with responsive disease received prophylactic cranial radiotherapy (25 Gy in 10 fractions). Randomisation was performed using a centralised interactive web response system, stratified by ECOG performance status, disease stage, previous chemotherapy course, and chemotherapy choice. The primary outcome was overall survival in the intention-to-treat population. Safety was analysed in the as-treated population. This study was registered at ClinicalTrials.gov, NCT03214003.
Findings: From June 30, 2017, to April 6, 2021, 224 patients (102 [46%] females and 122 [54%] males; median age 64 years [IQR 58-68]) were enrolled and randomly assigned to the 54 Gy group (n=108) or 45 Gy (n=116) group. The median follow-up was 46 months (IQR 33-56). The median overall survival was significantly longer in the 54 Gy group (60·7 months [95% CI 49·2-62·0]) than in the 45 Gy group (39·5 months [27·5-51·4]; hazard ratio 0·55 [95% CI 0·37-0·72]; p=0·003). Treatment was tolerable, and the chemotherapy-related and radiotherapy-related toxicities were similar between the groups. The grade 3-4 radiotherapy toxicities were oesophagitis (14 [13%] of 108 patients in the 54 Gy group vs 14 [12%] of 116 patients in the 45 Gy group; p=0·84) and pneumonitis (five [5%] of 108 patients vs seven [6%] of 116 patients; p=0·663). Only one treatment-related death occurred in the 54 Gy group (myocardial infarction). The study was prematurely terminated by an independent data safety monitoring board on April 30, 2021, based on evidence of sufficient clinical benefit.
Interpretation: Compared with standard-dose thoracic radiotherapy (45 Gy), high-dose radiotherapy (54 Gy) improved overall survival without increasing toxicity in a cohort of patients aged 18-70 years with LS-SCLC. Our results support the use of twice-daily accelerated thoracic radiotherapy (54 Gy) with concurrent chemotherapy as an alternative first-line LS-SCLC treatment option.
Funding: Chinese Society of Clinical Oncology-Linghang Cancer Research, the Wu Jieping Medical Foundation, and Clinical Research Fund For Distinguished Young Scholars of Peking University Cancer Hospital and Beijing Municipal Administration of Hospitals Incubating Program.
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老赵脑预防放疗出院回家一周了,几乎每天我都打电话给他,给妈妈。今天阿姨去我家了,我给妈妈打视频电话时,阿姨说:“看看你爸爸,走路像个小伙子”镜头转向爸爸,我看到他的背影,笑起来,转头又想哭😭谁能想到看着如此健康的人患恶性程度这么高的病呢?晚上睡觉前又给妈妈打视频,由于放疗,化疗后长出来的头发又掉光了,还是一片片掉的,很滑稽,我笑他,像哪吒。妈妈在旁边接话,你爸说从合肥回来家都瘦了,说我没有女儿照顾的好,等去住院给称称,你再给补回来,我笑说,好。要挂电话前爸爸说他头疼,我一下子心提到嗓子眼,怕脑转移,问清楚之后放下心了,原来是头皮一点点位置疼,摁压疼,不碰没感觉,我说没事放心吧!估计放疗灼伤了,25号入院开始第九次免疫啦!顺便复查,希望爸爸复查顺利,控制长长久久。
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小细胞肺癌复发后,再化疗有效吗?
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我跟我妈的日常视频,她不知道我拍摄,能看出她日常聊天风格,希望给大家带来欢乐[笑哭R][笑哭R][笑哭R][笑哭R]
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小细胞肺癌脑转移,中西结合不能少
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昨晚一个姐姐和我聊天,她说她爸爸也是小细胞肺癌,80岁,坚持了11个月走了。我说我爸爸刚刚过完58岁生日,59岁还没开始过就匆匆离开了。我说爸爸生病以后我全职陪护照顾,治疗上也是用尽了方案,我对爸爸没有遗憾了。可是,怎么可能会没有遗憾呢?我时常在想如果爸爸不抽烟不喝酒是不是就不会患肺癌?我如果每年都强硬坚持带他体检,而不是打电话让他去体检,结局会不会改变?2021年初做髋关节置换术入院常规查ct肺部有炎症,我警惕起来,即使医生说没事我也带去专科医院复诊,现在情况会不会不一样?再或者治疗期间化疗免疫的同时我如果坚持加放疗会不会不那么快复发?有太多后悔,太多遗憾!今天游泳的时候我又想你了,在水底眼泪汪汪模糊了泳镜,鼻子抽搐换气不受控制导致呛水爸爸,你生前担心我的颈椎,你要我好好照顾身体这样才能照顾好妈妈,我坚持游泳锻炼颈椎,缓解颈椎疼痛,如果还是不好我就去手术了。我坚持维持体重,保持健康身材,只有我好好的我才能照顾好妈妈——你最牵挂的人。你不要担心妈妈,我每天都给妈妈打电话,视频,她找到新的基督教会了,每周都和大婶子一起去祷告,妹妹也经常去看她,只是我每次和她联系都不
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这种肺癌,很小就会发生转移
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从绝望到希望,抗癌路上的坚持与重生
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癌就癌了,顺其自然,随遇而安;人生如逆旅,我亦是行人,加油癌友们!
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医生提醒:每天一包烟以上的老烟民更容易得小细胞肺癌,而且肺癌发展迅速!老烟民来听医生一句劝!
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