First-line ifosfamide, methotrexate, etoposide and prednisolone chemotherapy +/- radiotherapy is active in stage I/II extranodal NK/T-cell lymphoma

Although most patients diagnosed with extranodal NK/T-cell lymphoma (NTCL) have localized disease, radiotherapy alone is unsatisfactory because of frequent systemic failure and conventional doxorubicin-based chemotherapy has low efficacy. Twenty-six patients with NTCL received ifosfamide, methotrexate, etoposide and prednisolone (IMEP) chemotherapy as first-line treatment [ifosfamide 1.5 g/m² (days 1 - 3), methotrexate 30 mg/m² (days 3 and 10), etoposide 100 mg/m² (days 1 - 3) and prednisolone 120 mg (days 1 - 5)]. Radiotherapy was administered only to patients with Ann Arbor stage I/II that had not achieved complete remission (CR) or to those that developed local failure after completing chemotherapy. Sixteen patients (group A) had nasal or upper aerodigestive tract localization (stage I/II) and 10 (group B) had extranasal or disseminated disease. Of the 14 evaluable patients in group A, 11 (79%) achieved CR after IMEP alone and 13 (93%) after chemotherapy ± additional radiotherapy. Although, out of the 11 patients who achieved CR with chemotherapy alone, seven developed recurrence, all recurrences were local failure and successfully treated by additional curative radiotherapy. However, patients in group B responded poorly (CR 13%). IMEP regimen was active in NTCL patients with nasal or upper aerodigestive tract localization. Considering local failure rate after IMEP alone, initial IMEP chemotherapy followed by radiotherapy may be a promising treatment strategy in this subset of NTCL.     

Treatment outcome of angiocentric T-cell and NK/T-cell lymphoma, nasal type: radiotherapy versus chemoradiotherapy

OBJECTIVE: The purpose of this study was to evaluate the treatment outcome of angiocentric T-cell and natural killer (NK)/T-cell lymphoma, nasal type. METHODS: Between February 1989 and March 2001, 53 patients with newly diagnosed angiocentric T-cell and NK/T-cell lymphoma, nasal type involving the head and neck, were treated with radiation therapy (RT). There were 37 males and 16 females. The median age of the patients was 45 years (range 19-73). Twenty of them were treated with chemoradiotherapy (CRT), while 33 with treated with RT alone. The median follow-up period was 74 months (range 6-173). RESULTS: The 5-year overall survival rate of all patients was 69%. CRT appeared to be inferior to RT alone in terms of 5-year overall survival, though the difference was not statistically significant (59 versus 76%, P = 0.27). CONCLUSIONS: There was no difference in survival between RT and CRT in angiocentric T-cell and NK/T-cell lymphoma, nasal type.     

Therapeutic outcome of extranodal NK/T-cell lymphoma initially treated with chemotherapy--result of chemotherapy in NK/T-cell lymphoma

The therapeutic outcome of chemotherapy in NK/T cell lymphoma (NTCL) has not been well documented until now. The aims of this study were to investigate the outcome of chemotherapy and to evaluate the clinical factors influencing the responsiveness to chemotherapy. Between 1995 and 2000, 59 patients received anthracycline-based chemotherapy as an initial treatment. Forty-five patients had nasal NTCL, whereas 14 had extranasal NTCL. Forty-one patients had stage I/II and 18 had stage III/IV disease. Epstein-Barr virus status was positive in 67.6% of cases. The results of initial chemotherapy were complete remission in 35.6% of the patients, 2-year disease-free survival in 22.9% and 2-year overall survival in 44.2%. Adjuvant radiotherapy after chemotherapy did not improve outcome in stage I/II nasal NTCL. The International Prognostic Index was a significant prognostic factor of complete remission rate, and stage was also significant for disease-free survival.     

早期结外鼻型NK/T细胞淋巴瘤同期放化疗疗效分析

目的:探讨Ⅰ E～ⅡE期结外鼻型NK/T细胞淋巴瘤同期放化疗的疗效,并进一步分析其可行性.方法:回顾分析18例早期结外鼻型NK/T细胞淋巴瘤患者,以序贯化放疗50例为对照.18例同期放化疗患者中诱导化疗+同期放化疗+辅助化疗3例,诱导化疗十同期放化疗13例,同期放化疗十辅助化疗1例,单纯同期放化疗1例,全组放疗中位剂量54 Gy.结果:诱导化疗后的总缓解率为50.0％(8/16),治疗结束后为100.0％(18/18).同期放化疗组与对照组的5年总生存率分别为80.8％和54.3％(x2=3.66,P=0.05),5年无进展生存率(PFS)分别为75.8％和43.3％(x2=6.13,P=0.01),5年局部控制(LC)率分别为94.1％和56.7％(x2=6.32,P-0.01).同期放化疗过程中出现Ⅲ～Ⅳ度骨髓抑制率为27.8％(5/18),Ⅲ度口腔黏膜反应率为16.7％(3/18),Ⅲ度咽喉反应率为5.6％(1/18),其余不良反应均 为Ⅰ～Ⅱ度,Ⅲ～Ⅳ反应经对症处理后未影响下一步治疗.结论:同期放化疗是早期结外鼻型NK/T细胞淋巴瘤安全、有效的治疗方法,相对其他接受放疗患者有提高局部控制率和生存时间的趋势,其毒副反应可以耐受.     

Ki-67 expression is predictive of prognosis in patients with stage I/II extranodal NK/T-cell lymphoma, nasal type.

BACKGROUND: Localized extranodal natural killer (NK)/T-cell lymphoma, nasal type, commonly has a low or low-intermediate risk of the international prognostic index (IPI), so the IPI has shown inconsistency in predicting prognosis. Thus, we analyzed Ki-67 expression and proposed a new prognostic model including Ki-67 expression for stage I/II extranodal NK/T-cell lymphoma. PATIENTS AND METHODS: We studied Ki-67 expression and its relationship with prognosis in 50 patients with extranodal NK/T-cell lymphoma. RESULTS: The patients were dichotomized by the median value: low (<65%) versus high Ki-67 (> or =65%). High Ki-67 was associated with a worse overall survival (OS; P = 0.021) and disease-free survival (DFS; P = 0.044). In multivariate analysis, Ki-67 expression and primary site of involvement were found to be an independent prognostic factor for OS and DFS (P < 0.05). Based on these results, we proposed a new clinico-pathological prognostic model with Ki-67 expression and the primary site of involvement. It showed a high degree of correlation with worse OS and DFS (P < 0.001). CONCLUSIONS: Ki-67 expression is predictive of prognosis, and our prognostic model may become a useful tool for predicting prognosis in patients with stage I/II extranodal NK/T-cell lymphoma, nasal type.     

Radiotherapy combined with chemotherapy versus radiotherapy alone for early stage nasal natural killer/T-cell lymphoma: a meta-analysis

Objective: To compare the efficacy of radiotherapy (RT) plus chemotherapy (CMT) versus RT alone for early stage nasal natural killer (NK)/T-cell lymphoma.

Methods: All the eligible studies were searched by PubMed, Medline, Embase and the Cochrane Library. The meta-analysis was performed to compare odds ratios (ORs) for overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS).

Results: Eight studies were included in the meta-analysis. Chemotherapy group did not significantly differ from RT group. The pooled OR and 95% confidence interval (CI) for 1-year, 3-year, 5-year and 10-year OS was 1.25 [0.84, 1.87], 1.10 [0.76, 1.58], 0.83 [0.59, 1.17] and 1.05 [0.70, 1.56]. In addition, the combined OR and 95% CI for 5-year DFS and PFS were 0.96 [0.53, 1.73] and 0.71 [0.45, 1.12].

Conclusions: The current evidence suggests that CMT was not superior to RT alone. Radiotherapy may be still the main method in the treatment of early stage nasal NK/T-cell lymphoma.     

Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer

The purpose of the present paper was to evaluate treatment outcome after conservative breast surgery or mastectomy followed by simultaneous adjuvant radiotherapy and cyclophosphamide, methotrexate and fluorouracil (CMF) therapy. Two hundred and sixty eight (268) patients were treated at two Australian and two New Zealand centres between 1981 and July 1995. One hundred and sixty-nine patients underwent conservation surgery and 99 had mastectomies. Median follow-up was 53 months. Conventionally fractionated radiation was delivered simultaneously during the first two cycles of CMF, avoiding radiation on the Fridays that the intravenous components of CMF were delivered. In conservatively treated patients, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 34.5 ± 5.2%, 25.4 ± 4.5% and 75.5 ± 4.8%, respectively. Crude incidence of local relapse at 4 years was 6.3% and at regional/distant sites was 26.3%. Highest grades of granulocyte toxicity (< 0.5 × 10⁹/L), moist desquamation, radiation pneumonitis and persistent breast oedema were recorded in 10.7, 8.5, 8.9 and 17.2%, respectively. In patients treated by mastectomy, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 59.7 ± 7.3%, 56.7 ± 7.4% and 50.1 ± 7%. The crude incidence of local relapse at 4 years was 5.6% and at regional/distant sites it was 45.7%. The issue of appropriate timing of adjuvant therapies has become particularly important with the increasing acknowledgement of the value of anthracycline-based regimens. For women in lower risk categories (e.g. 1–3 nodes positive or node negative), CMF may offer a potentially better therapy, particularly where breast-conserving surgical techniques have been used. In such cases CMF allows the simultaneous delivery of radiotherapy with the result of optimum local control, without compromise or regional or systemic relapse rates. Further randomized trials that directly address the optimal integration of the two modalities, such as the one carried out in Boston, are clearly necessary.     

早期结外鼻型NK/T细胞淋巴瘤GDL方案治疗的临床观察

目的:评价吉西他滨、地塞米松和左旋门冬酰胺酶组成的GDL方案对结外鼻型NK/T细胞淋巴瘤的疗效和毒副作用。方法:GDL方案:盐酸吉西他滨1 000mg/m2加入生理盐水100mL中,静脉滴入,d1、d8;地塞米松10mg/m2,静脉滴入,d1～d5;左旋门冬酰胺酶5 000U/m2加入5%葡萄糖250mL中,静脉滴入,d1～d7,21d为1个周期。全组48例患者接受4个周期化疗后评价疗效,3周后行累及野放射治疗后。结果:完全缓解(CR)率为54.2%(26/48),部分缓解(PR)率为35.4%(17/48),疾病稳定(SD)率为8.3%(4/48),疾病进展(PD)率为2.1%(1/48),经放射治疗后全组CR率91.7%(44/48),PR率为8.3%(4/48),有效率100%。中位随访36(10～58)个月,预期3年生存率和无进展生存期分别为79%和75%。主要不良反应为骨髓抑制、胃肠道反应和血糖波动等,大多为轻中度,且化疗停止后很快缓解。无治疗相关死亡。结论:GDL方案治疗结外鼻型NK/T细胞淋巴瘤的疗效佳,毒副作用下且能耐受,联合累及野放疗治疗能够取得较为满意的疗效,值得进一步临床推广使用。     

Extranodal NK/T-cell lymphoma mimicking cellulitis

NK/T-cell lymphoma is difficult to diagnose because there is no characteristic cytology to help the diagnosis in tissue sections, particularly when there is polymorphic cellular infiltration in the early stage of the disease. However, the nasal type of extranodal NK/T-cell lymphoma has a characteristic histologic pattern, which is angiocentric, angioinvasive and angiodestructive. Therefore, many cases of this tumor may show extensive necrosis that mimics infectious process. Furthermore, because the immunosuppressive status of these patients, they may, in fact, have superimposed infections. We are reporting a case that presented as cellulitis and only after careful examination with immunohistochemistry that a correct diagnosis of extranodal NK/T-cell lymphoma, nasal type, was established. Since this lymphoma is incurable and immunophenotyping is instrumental for the diagnosis and prediction of the prognosis, a high index of suspicion for this tumor is needed when an angiocentric lesion is found in the midline of the head and neck region, and a thorough immunohistological study should always be conducted in these cases.     

Combination chemotherapy only for stage II non-Hodgkin's lymphoma

Twenty-six previously untreated patients with clinical stage (CS) II B non-Hodgkin's lymphoma (NHL) were treated with systemic chemotherapy only. Patients received bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP). All patients had intermediate- or high-grade lymphoma. Objective response was demonstrated in 25 patients (96%), with 21 patients (81%) achieving complete remission (CR). Two of CR patients developed unsalvageable relapse, the remaining 19 patients are still alive and disease-free. The median duration of CR has not been reached. Of four patients (15%) with documented partial remission (PR), three were salvaged using second-line therapy. Over a median follow-up of 12 months (range, 3–30), 22 patients (85%) are alive and disease-free, of whom 16 (62%) have survived more than 1 yr. Bulky disease or gastrointestinal tract (GIT) involvement did not influence the CR rate. Our results compared favorably with radiation therapy for stage II NHL; however, a larger controlled and randomized study is warranted.     

Phase I/II trial of chemoradiotherapy with concurrent S‐1 and cisplatin for clinical stage II/III esophageal carcinoma (JCOG 0604)

We carried out a phase I/II trial of chemoradiotherapy concurrent with S‐1 and cisplatin to determine the maximum tolerated dose and recommended dose and to evaluate the efficacy and safety of this treatment in patients with esophageal carcinoma. Thoracic esophageal cancer patients with clinical stage II/III disease, excluding T4, were eligible. Chemotherapy consisted of S‐1 at a dose of 60–80 mg/m²/day on days 1–14, and cisplatin at 75 mg/m² on day 1, repeated twice every 4 weeks. Single daily radiation of 50.4 Gy was given in 28 fractions concurrently starting on day 1. Patients achieving an objective response after chemoradiotherapy underwent two additional cycles of chemotherapy. Patient accrual was terminated early due to slow enrolment after 44 patients were accrued. In the phase I part, two of six patients experienced dose‐limiting toxicities at each level of S‐1 (S‐1 60 or 80 mg/m²/day). Considering treatment compliance, the recommended dose was determined to be S‐1 60 mg/m²/day. The complete response rate, the primary endpoint of phase II, was 59.5% (22/37; 90% confidence interval, 44.6–73.1%; weighted threshold, 57.2%; P = 0.46 by the exact binomial test) on central review. In the phase II part, 3‐year progression‐free survival was 48.4%, with a 3‐year overall survival of 61.9%. Grade 3 or 4 toxicity in phase II included leukopenia (57.9%), neutropenia (50%), hyponatremia (28.9%), anorexia (21.1%), anemia (18.4%), thrombocytopenia (18.4%), and febrile neutropenia (2.6%). No treatment‐related deaths were observed. Although this combination showed acceptable toxicity and favorable 3‐year survival, the study did not meet its primary endpoint. This trial was registered at the UMIN Clinical Trials Registry as UMIN000000710.     

结外鼻型NK/T细胞淋巴瘤放化疗研究进展

结外鼻型NK/T细胞淋巴瘤（extranodal NK/T-cell lymphoma,nasal type ENKTL）是侵袭性非霍奇金淋巴瘤的一种特殊类型,由于发病率低,目前临床治疗证据大部分来自回顾性分析或小样本的Ⅱ期临床试验,缺乏大型的随机对照研究,暂无统一的治疗标准。放疗、化疗是ENKTL的主要治疗方法,但目前放、化疗策略选择仍存在争议性,是否联合放化疗、放化疗联合方式、化疗方案选择等方面均未形成统一的认识。对于早期（Ⅰ/Ⅱ期）患者目前多以放疗联合化疗的治疗方法,Ⅲ/Ⅳ期患者多采用以全身化疗为主。以L-门冬酰胺酶（L-ASP）为基础的化疗药物在各期及复发难治性ENKTL中疗效结果显示均较CHOP或CHOP样化疗方案好。最佳的化疗方案以及化疗与放疗结合方式仍需通过更多的、更大型的Ⅲ期随机对照试验来证实。寻找准确的预后因素进行风险分层,根据风险分层结果进行治疗是未来的研究热点和方向。本文将有关放、化疗的研究进展进行综述,以期对该病的治疗提供参考性指导。     

Alternating chemotherapy and radiotherapy combination for bulky stage I and II intermediate and high grade non-Hodgkin lymphoma: an update

In 1980, based on experimental and clinical data, a protocol was developed at the Institut Gustave-Roussy (IGR), alternating eight monthly courses of chemotherapy (CHVP) and two, then three, radiotherapy sequences (15 Gy in 6 fractions and 10 days to the initially involved areas), for early stage unfavourable histology non-Hodgkin lymphomas (NHL). The results are updated for 55 selected patients presenting with bulky stage I and II NHL, intermediate and high grade according to the Working Formulation. Five-year overall survival rate was 69% and freedom from progression was 68%. Early haematologic and digestive tolerance was satisfactory, probably because a 10-15-day interval was respected between chemotherapy and radiotherapy and vice versa. No late toxicity was detected in 39 patients who presented with head and neck localizations; xerostomia was found to be only mild and transient. All patients given mediastinal irradiation experienced radiological mediastinitis, but functional impairment was usually moderate. One of the 4 patients who received 3 x 15 Gy radiotherapy courses to part of the abdomen, died of small bowel obstruction and perforation. The study demonstrated the feasibility of an alternated schedule of chemotherapy and radiotherapy, with satisfactory results in terms of long-term survival. However, the few late complications which were detected after irradiation of the abdomen or of the thorax led to an alteration of the initial scheme when these volumes are to be treated.     

外周T细胞淋巴瘤和NK/T细胞淋巴瘤指南的更新解读

外周T细胞淋巴瘤(peripheral T-cell lymphoma,PTCL)是来源于胸腺后不同阶段的生物学行为及临床表现具有明显异质性的一类恶性淋巴肿瘤。诊断时多为晚期且进展迅速,即使接受高强度的治疗,治愈率仍较低。结外NK/T细胞淋巴瘤(extranodal NK/T-cell lymphoma,ENKTL)为原发于鼻腔或其他结外器官的NK/T细胞淋巴瘤,属于结外非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)的一种少见特殊类型,占NHL的5%～15%。其发病具有明显的地域和种族差异性,亚洲人群相对高发。ENKTL恶性程度高、临床进展快且预后差。寻求更为标准化、规范化的诊疗指导,学习并理解国际及国内的权威指南尤为重要。本文将对中国临床肿瘤学会(CSCO)淋巴瘤指南以及美国肿瘤学临床实践(NCCN)指南等进行解读,重点对近两年(2019年至2020年)指南中PTCL及自然杀伤T细胞淋巴瘤(natural killer T-cell lymphoma,NKTCL)的部分更改和新增内容进行总结。     

Ⅳ期寡转移NSCLC同期放化疗后巩固化疗前瞻性Ⅱ期临床研究

目的 研究寡转移NSCLC行胸内病灶根治性同期放化疗后巩固化疗的疗效和不良反应。方法 2008—2013年间转移灶≤5个的NSCLC患者66例入组。放疗采用IGRT, 常规分割或大分割。同期及巩固化疗均以铂类为基础两药联合方案。治疗结束后评价患者近期疗效、不良反应和生存率。结果 64例完成治疗。胸内病灶PTV中位BED为72 Gy, 中位化疗周期数4个。胸内病灶客观缓解率为70%。随访率为97%。1、2、3年OS分别为72%、53%、31%, 中位OS时间25个月;1、2、3年PFS分别为56%、26%、7%, 中位PFS时间14个月。2+3级急性放射性肺炎、放射性食管炎发生率分别为11%和17%, 3+4级白细胞、血红蛋白、血小板计数减少率分别为39%、11%、16%。结论 寡转移NSCLC胸内病灶根治性放疗联合同期化疗及巩固化疗, 可获得较好近期疗效和长期生存, 不良反应可耐受。     

Adjuvant concurrent chemoradiotherapy with intensity-modulated pelvic radiotherapy after surgery for high-risk, early stage cervical cancer patients

PURPOSE: This study was undertaken to assess local control and toxicity with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy (CCRT) for early stage cervical cancer. PATIENTS AND METHODS: Between June 2004 and February 2007, 54 patients with early stage cervical cancer (stage IB-IIA) with high-risk factors for treatment failure after surgery were treated with adjuvant pelvic IMRT and CCRT. Adjuvant chemotherapy consisted of cisplatin (50 mg/m2) weekly for 4 to 6 courses. All the patients received 50.4 Gy of external beam radiotherapy with IMRT in 28 fractions and 6 Gy of high-dose rate vaginal cuff brachytherapy in 3 insertions. RESULTS: Adjuvant CCRT with IMRT provided good local tumor control in posthysterectomy cervical cancer patients with high-risk pathologic features. The 3-year locoregional control and disease-free survival were 93% and 78%, respectively. Histology and lymph node metastasis were indicators for disease-free survival. Low acute and chronic treatment-related toxicities were noted with IMRT. All the patients completed the radiotherapy treatment without any major toxicity. In terms of chronic toxicity, only 1 patient had grade 3 genitourinary toxicity and none had grade 3 gastrointestinal toxicity. CONCLUSION: Our results indicate that adjuvant CCRT with IMRT technique for adjuvant treatment of early stage cervical cancer is associated with excellent local control and low toxicity.     

Long-term outcomes of concurrent chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma treated with IMRT: a retrospective study

Tumor Biology - This study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) for stage II nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation...     

Phase I/II trial evaluating concurrent carbon-ion radiotherapy plus chemotherapy for salvage treatment of locally recurrent nasopharyngeal carcinoma

Background:After deifnitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma (NPC), more than 10% of patients will experience a local recurrence. Salvage treatments present signiifcant challenges for locally recur-rent NPC. Surgery, stereotactic ablative body radiotherapy, and brachytherapy have been used to treat locally recur-rent NPC. However, only patients with small-volume tumors can beneift from these treatments. Re-irradiation with X-ray—based intensity-modulated radiotherapy (IMXT) has been more widely used for salvage treatment of locally recurrent NPC with a large tumor burden, but over-irradiation to the surrounding normal tissues has been shown to cause frequent and severe toxicities. Furthermore, locally recurrent NPC represents a clinical entity that is more radio-resistant than its primary counterpart. Due to the inherent physical advantages of heavy-particle therapy, precise dose delivery to the target volume(s), without exposing the surrounding organs at risk to extra doses, is highly feasible with carbon-ion radiotherapy (CIRT). In addition, CIRT is a high linear energy transfer (LET) radiation and provides an increased relative biological effectiveness compared with photon and proton radiotherapy. Our prior work showed that CIRT alone to 57.5 GyE (gray equivalent), at 2.5 GyE per daily fraction, was well tolerated in patients who were pre-viously treated for NPC with a deifnitive dose of IMXT. The short-term response rates at 3–6months were also accept-able. However, no patients were treated with concurrent chemotherapy. Whether the addition of concurrent chemo-therapy to CIRT can beneift locally recurrent NPC patients over CIRT alone has never been addressed. It is possible that the beneifts of high-LET CIRT may make radiosensitizing chemotherapy unnecessary. We therefore implemented a phase I/II clinical trial to address these questions and present our methodology and results. Methods and design:The maximal tolerated dose (MTD) of re-treatment using raster-scanning CIRT plus concur-rent cisplatin will be determined in the phase I, dose-escalating stage of this study. CIRT dose escalation from 52.5 to 65 GyE (2.5 GyE×21–26 fractions) will be delivered, with the primary endpoints being acute and subacute toxicities. Effcacy in terms of overall survival (OS) and local progression-free survival of patients after concurrent chemotherapy plus CIRT at the determined MTD will then be studied in the phase II stage of the trial. We hypothesize that CIRT plus chemotherapy can improve the 2-year OS rate from the historical 50% to at least 70%. Conclusions:Re-treatment of locally recurrent NPC using photon radiation techniques, including IMXT, provides moderate effcacy but causes potentially severe toxicities. Improved outcomes in terms of effcacy and toxicity proifle are expected with CIRT plus chemotherapy. However, the MTD of CIRT used concurrently with cisplatin-based chemo-therapy for locally recurrent NPC remains to be determined. In addition, whether the addition of chemotherapy to CIRT is needed remains unknown. These questions will be evaluated in the dose-escalating phase I and randomized phase II trials.     

局限期小细胞肺癌调强适形放疗同步化疗的临床研究

目的:观察分析调强适形放疗同步化疗与序贯放化疗治疗局限期小细胞肺癌的疗效、毒副反应及生活质量。方法:45例局限期小细胞肺癌患者被随机分成精确放疗加同步化疗组(同步组,23例)与化疗后再放疗组(序贯组,22例)。同步组在化疗的第1个周期开始放疗,序贯组化疗4～6个周期后再进行放疗。两组患者化疗方案均为EP方案,均接受精确放疗,1次/d,(1.8～2.0)Gy/次,5次/周,共28～31次,总剂量50.4～62.0Gy。照射野包括原发病灶和转移淋巴结。结果:同步组和序贯组原发病灶总有效率为95%和86%;12和18个月生存率分别为84%、69%和76%、34%。两组患者的毒副反应均以急性骨髓抑制、放射性食管炎及放射性肺炎为主。同步组Ⅰ～Ⅱ级放射性食管炎和放射性肺炎发生率分别为78%和86%,与序贯组的73%和81%近似。Ⅲ～Ⅳ级急性骨髓抑制发生率同步组和序贯组分别为8%、9%。生活质量QOL评分同步组和序贯组治疗前后差异无统计学意义。结论:调强适形放疗同步化疗局限期小细胞肺癌有较好的疗效,毒副反应为绝大多数患者耐受且生活质量无明显下降,但值得进一步研究。