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目的研究广泛期小细胞肺癌(SCLC)一线治疗,依托泊苷联合顺铂方案(EP)序贯伊立替康联合顺铂方案(IP)在疾病稳定患者中的疗效及不良反应发生情况。方法回顾性分析55例初治广泛期小细胞肺癌患者的病历资料,所有患者均使用EP方案化疗2个周期,且疗效评估稳定。根据治疗方法不同将患者分为两组,其中采用序贯IP方案治疗者25例为EP+IP组,继续应用EP方案治疗者30例为EP组,所有患者均完成至少4个周期化疗,每个周期评价不良反应,每2个周期评价疗效,并对两组患者的治疗效果及不良反应发生情况进行比较。结果 55例患者中,EP+IP组CR 0例,PR 17例,SD 6例,PD 2例,ORR为68.0%;EP组CR 0例,PR 8例,SD 17例,PD 5例,ORR为26.7%;EP+IP组患者的中位PFS为7.0个月,OS为16.0个月;EP组患者的中位FPS为5.0个月,OS为12.0个月,差异有统计学意义(P﹤0.05)。两组患者不良反应主要为血液学和消化道不良反应,EP+IP组的白细胞减少、血小板减少发生率低于EP组,差异有统计学意义(P﹤0.05);而EP+IP组迟发性腹泻发生率高于EP方案组,但多为1~2级,患者均可耐受,无化疗相关性死亡。结论广泛期小细胞肺癌一线治疗EP方案疗效评估稳定的患者,序贯IP方案化疗优于继续应用EP方案,不良反应可耐受。
Objective To investigate the efficacy and side effects of first-line treatment of extensive-stage small cell lung cancer (SCLC) and sequential therapy with etoposide plus cisplatin (EP) in patients with stable disease and sequential therapy with irinotecan plus cisplatin. Methods Retrospective analysis of 55 cases of newly diagnosed patients with extensive stage of small cell lung cancer records, all patients were treated with EP regimen 2 cycles, and the efficacy of evaluation was stable. According to different treatment methods, the patients were divided into two groups, including 25 cases treated with sequential IP regimen as EP + IP group and 30 cases treated with EP regimen as EP group. All patients completed at least 4 cycles of chemotherapy, A cycle of adverse reactions were evaluated, the efficacy was evaluated every 2 cycles, and the treatment effect and adverse reactions of the two groups were compared. Results Among the 55 patients, there were CR 0, PR 17, SD 6 and PD 2 in the EP + IP group, with an ORR of 68.0%. In the EP group, CR 0, PR 8, SD 17, PD 5, OR Was 26.7%. The median PFS in EP + IP group was 7.0 months and the OS was 16.0 months. The median FPS in EP group was 5.0 months and OS was 12.0 months, the difference was statistically significant (P < 0.05). Adverse reactions in the two groups were mainly hematological and gastrointestinal adverse reactions. The incidences of leukopenia and thrombocytopenia in EP + IP group were lower than those in EP group (P <0.05), while those in EP + IP group were delayed The incidence of diarrhea was higher than the EP group, but mostly in grade 1 to 2, patients were tolerated without chemotherapy-related deaths. Conclusion The first-line treatment of extensive-stage small cell lung cancer patients with stable response to EP regimen, sequential IP regimen is better than the continued use of EP regimen, adverse reactions can be tolerated.