局限期小细胞肺癌首程治疗失败后再程治疗的相关研究

目的 本文回顾性分析小细胞肺癌(Small cell lung cancer,SCLC)患者首程放化疗后复发或进展后行再程治疗的疗效、毒性反应、生存情况及影响预后的相关因素。方法 收集哈尔滨医科大学附属肿瘤医院2007年1月—2015年12月治疗的SCLC放化疗后复发或进展行再程治疗的患者共计86例,将患者分为再程放化综合治疗组、再程单纯放疗组和再程单纯化疗组。分析影响SCLC再程治疗预后的相关因素,比较三组患者再程治疗后近期及远期疗效、总生存时间及毒性反应情况。结果 本研究再程放化综合治疗组、单纯放疗组和单纯化疗组的中位无疾病进展生存时间分别为4个月(1~20个月)、2个月(1~7个月)和3个月(1~16个月),无统计学差异(P＞0.05);放化综合治疗组、单纯放疗组和单纯化疗组中位总生存时间分别是25个月(3~135个月)、8个月(1~59个月)和12个月(1~108)个月,差异有统计学意义(P＜0.05)。对于1、2、3年生存率:再程放化综合治疗组分别为73.70%、52.10%和47.40%;单纯放疗组分别为32.90%、21.90%和21.90%;单纯化疗组为45.40%、19.90%和19.90%。提示再程放化综合治疗组的远期效果优于单纯放疗组和单纯化疗组(P＜0.05)。结论 对首程接受放化疗后失败的SCLC患者行再程治疗能延长患者的生存时间、改善患者生存质量;在患者身体状况允许的情况下,再程治疗应选择放化综合治疗且毒副反应可耐受。其中,无远处转移、再程放疗剂量≥5 000 cGy的患者生存获益更大。但患者接受再程治疗后的晚期毒副反应及并发症尚有待于进一步观察。

Correlation study of recurrent treatment after limited first-course treatment of small cell lung cancer

Objective This article retrospectively analyzed the efficacy,toxicity,survival and related factors affecting prognosis of patients with small cell lung cancer(SCLC)who had recurrence or progression after first-course chemoradiotherapy.Methods A total of 86 patients with recurrence or progression recurrence after SCLC chemotherapy and radiotherapy from January 2007 to December 2015 in Harbin Medical University Cancer Hospital were enrolled.Patients were divided into the re-treatment group to receive secondary treatment with radiotherapy combined with chemotherapy and two control groups to receive secondary treatment with radiotherapy alone or chemotherapy alone.The factors affecting the prognosis of SCLC re-treatment were analyzed.The short-term and long-term efficacy,overall survival and toxicity of three groups were compared.Results The median progression-free survival time of the re-treatment group,radiotherapy group,and chemotherapy alone group was 4 months(1~20 months),2 months(1~7 months)and 3 months(1~6 months).There was no statistical difference(P＞0.05).The median overall survival time was 25 months(3~135 months)in the re-treatment group and 8 months in the radiotherapy group(1-59 months)and 12 months(1~108)in the chemotherapy alone group,the difference was statistically significant(P＜0.05).The 1-,2-,and 3-year survival rates were 73.70%,52.10% and 47.40% in the re-treatment group;32.90%、21.90% and 21.90% in the radiotherapy group,and 45.40%,19.90% and 19.90% in the chemotherapy alone group.The long-term effect of the re-treatment group was better than that of the radiotherapy group and the chemotherapy alone group(P＜0.05).Conclusion Re-treatment of patients with SCLC who failed after receiving radiotherapy and chemotherapy for the first time can prolong the survival time of patients and improve the life quality of patients.If the patient's physical condition permits,the treatment should be selective radiotherapy and chemotherapy as well as tolerable toxicity or side effects.Among them,patients with no distant metastasis and recurrent radiotherapy dose ≥5 000 cGy had greater survival benefit.However,the late toxic and side effects,and complications of patients after re-treatment are still to be further observed.