臨床外科60巻6号

2005年06月発行

特集 化学放射線療法―現状とイメージングによる効果判定

肺がんの化学放射線療法

著者： 坪井正博¹ 加藤治文¹

所属機関： ¹東京医科大学外科第Ⅰ講座

ページ範囲：P.765 - P.775

要旨：限局型小細胞肺癌に対する化学療法単独と化学療法＋TRT併用療法を比較したメタアナリシスから，化学放射線療法併用群が化学療法単独群より3年生存率で5.4％の上積みがあり，死亡率で14％低いことが示されている．また切除不能Ⅲ期非小細胞肺癌に対しても，化学放射線併用療法は2年生存率で7～25％の上乗せ効果があることが報告されている．したがって，化学放射線療法は少なくともplatinumを含む化学療法との併用でその有効性が明らかにされ，併用のタイミングは逐次併用より同時併用がより有効的であることが証明されている．しかし，同時併用では毒性が増すことは明らかであり，PS，背景肺の状態などその適応決定には慎重を要する．特に高齢者が多い実地医療レベルでは，両者の副作用が重ならないことにも留意すべきである．今後，より安全かつ有効な効果を得るためには，分子標的治療薬を含めた抗がん剤の選択，投与のタイミング，放射線の照射方法などのさらなる検討が必要である．

参考文献

1）佐々木武仁：Chemoradiotherapyの生物学的基礎．肺癌の臨床2：5-14，1999

2）Byhardt RW, Cox JD：Is chest radiotherapy necessary in any or all patients with small cell carcinoma of the lung? Yes. Cancer Treat Rep 67：209-221, 1983

3）Pignon JP, Arrigada R, Ihde DC, et al：A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327：1618-1624, 1992

4）Warde P, Payne D：Dose thoracic irradiation improve survival and local control in limited-stage small cell carcinoma of the lung? A meta-analysis. J Clin Oncol 10：890-895, 1992

5）Murray N, Coy P, Peter JL, et al：Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small cell lung cancer. J Clin Oncol 11：336-344, 1993

6）Jeremic B, Shibamoto Y, Acimovic L, et al：Initial versus delayed accelerated hyperfractionated radiation therapy and concurrent chemotherapy in limited small-cell lung cancer：A randomized study. J Clin Oncol 15：893-900, 1997

7）Tsukada H, Yokoyama A, Goto K, et al：Concurrent versus sequential radiotherapy for small cell lung cancer. Seminars in Oncol 28（suppl 4）：23-26, 2001

8）Turrisi AT, Kim K, Blum R, et al：Twice-daily compared with once-daily thoracic radiotherapy in limited small cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340：265-271, 1999

9）Dillman RO, Seagren SL, Propert KJ, et al：A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stageⅢnon-small cell lung cancer. N Engl J Med 323：940-945, 1990

10）Sause W, Scott C, Taylor S, et al：RTOG88-08 and ECOG4588：Preliminary results of a phaseⅢtrial in regionally advanced unresectable non-small-cell lung cancer. J Natl Cancer Inst 87：198-205, 1995

11）Furuse K, Fukuoka M, KawaharaM, et al：PhaseⅢstudy of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stageⅢnon-small-cell lung cancer. J Clin Oncol 17：2692-2699, 1999

12）Schild SE, Stella PJ, Geyer SM, et al：PhaseⅢtrial comparing chemotherapy plus once-daily or twice-daily radiotherapy in StageⅢnon-small-cell lung cancer. Int J Radiat Oncol Biol Phys 54：370-378, 2002

13）Stella P, Marks R, Schild S, et al：PhaseⅢtrial of chemotherapy plus either standard radiotherapy（QD-RT）or accelerated hyperfractionated thoracic radiotherapy（AHTRT）for stageⅢnon-small cell lung cancer（NSCLC）. Proc Am Soc Clin Oncol 20：312a, 2001

14）Rice TW, Adelstein DJ, Koka A, et al：Accelerated induction therapy and resection for poor prognosis stageⅢnon-small cell lung cancer. Ann Thorac Surg 60：586-592, 1995

15）Choi NC, Carey RW, Daly W, et al：Potential impact on survival of improved tumor downstaging and resection rate by preoperative twice-daily radiation and concurrent chemotherapy in stageⅢA non-small cell lung cancer. J Clin Oncol 15：712-722, 1997

16）Eberhart W, Wilke H, Stamatis G, et al：Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small cell lung cancer；mature results of a phaseⅡtrial. J Clin Oncol 16：622-532, 1998

17）Choy H, Safran H, Akerly W, et al：PhaseⅡtrial of weekly paclitaxel and concurrent radiationtherapy for locally advanced non-small cell lung cancer（NSCLC）. Clin Can Res 4：1931-1936, 1998

18）Pierre F, Maurice P, Gilles R, et al：A randomized phaseⅢtrial of sequential chemoradiotherapy versus concurrent chemoradiotherapy in locally advanced non small cell lung cancer（NSCLC）（GLOT-GFPC NPC 95-01 study）. Proc Am Soc Clin Oncol 20：312a, 2001

19）Gandara DR, Chansky K, Albain KS, et al：Consolidation docetaxel after concurrent chemoradiotherapy in stageⅢB non-small-cell lung cancer：phaseⅡSouthwest Oncology Group Study S9504. J Clin Oncol 21：2004-2010, 2003

20）Socinski MA, Morris DE, Halle JS, et al：Induction and concurrent chemotherapy with high-dose thoracic conformal radiation therapy in unresectable stageⅢA andⅢB non-small-cell lung cancer：a dose-escalation phase I trial. J Clin Oncol 22：4341-4350, 2004

21）Kubota K, Nishiwaki Y, Sugiura T, et al：A pilot study of cisplatin and etoposide plus concurrent accelerated hyperfractionated thoracic radiotherapy（TRT）followed by three cycles of irinotecan and cisplatin for the treatment of limited-stage small-cell lung cancer（SCLC）：JCOG9903-DI. Proc Am Soc Clin Oncol 20：345a, 2001

22）Choy H, Nabid A, Stea B, et al：Positive phaseⅡresults of RSR13 and concurrent radiation therapy after induction chemotherapy with paclitaxel and carboplatin for locally advanced inoperable non-small cell lung cancer. Proc Am Soc Clin Oncol 20：313a, 2001

23）Komaki R, Lee JS, Kaplan B, et al：Randomized phaseⅢstudy of chemoradiation with or without amifostine for patients with favorable performance status inoperable stageⅡ-Ⅲnon-small cell lung cancer：preliminary results. Semin Radiat Oncol 12：46-49, 2002

24）Leong SS, Tan EH, Fong KW, et al：Randomized double-blind trial of combined modality treatment with or without amifostine in unresectable stageⅢnon-small-cell lung cancer. J Clin Oncol 21：1767-1774, 2003