212例局限期小细胞肺癌放射及综合治疗效果

目的 评价局限期小细胞肺癌(LD-SCLC)治疗效果及其预后因素。方法采用回顾性分析方法观察经病理或细胞学证实的局限期小细胞肺癌212例,均接受2~6个周期化疗,其中59例单纯化疗,108例化疗+放疗,45例化疗+手术±放疗。6或10 MV X射线照射,剂量40~66 Gy,4~7周完成。结果总中位生存时间(MST)15个月,1、2、3年生存率分别为58.0%、 33.2%、22.1%。单因素分析提示体重下降、年龄、治疗初乳酸脱氢酶(LDH)水平及东部肿瘤协作组(ECOG)评分、是否手术、放化疗近期疗效、化疗周期数、放化疗时放疗的参与等因素影响患者生存期。Cox多因素分析结果提示ECOG评分、化疗周期数、放化疗疗效是影响患者生存的独立预后因素。 失败原因包括胸腔内复发占22.2%,远处转移占47.5%,胸内复发+远处转移占30.3%。结论ECOG评分≤1、进行4个周期以上化疗以及放化疗近期疗效好的患者预后较好。远处转移仍是治疗失败的主要原因。

Treatment of 212 patients with limited-disease small cell lung cancer

Objective To review the treatment effect of limited disease small cell lung cancer (LD-SCLC) and to evaluate the prognosis factors for SCLC. Methods From Aug. 2002 to Feb. 2006, 212 patients of SCLC confirmed with pathology and cytology were. Treated by combined modality. All patients were treated with chemotherapy 2-6 cycles, 59 patients of which were treated with only chemotherapy, 108 patients of which were treated with chemotherapy plus radiotherapy, 45 patients of which were treated with surgery plus chemotherapy with or without radiotherapy. The patients of radiotherapy were exposed to 6 or 10 MV X-ray with a total dose of 40-66 Gy in 4-7 weeks. Results The overall median survival time was 15 months. The 1-,2- and 3-year overall survival rate were 58.0%, 33.2% and 22.1%, respectively. Univariate analysis indicated that weight loss, age, LDH, ECOG performance status, operation, response to radio-chemotherapy, cycles for chemotherapy, radiotherapy irflueoced survival significantly in LD-SCLC. Multivariate analysis suggested that ECOG performance status, response to therapy, cycles for chemotherapy were the independent prognostic factors for LD-SCLC. Conclusions For LD-SCLC patients, ECOG performance ≤ 1, good response to radio-chemotherapy, and ≥ 4 cycles chemotherapy show encouraging survival rate, Distance metastasis is still the mainstay of treatment failure.