无锁骨上淋巴结转移的局限期小细胞肺癌颈部预防照射临床分析

目的:比较颈部预防照射对无锁骨上淋巴结转移的局限期小细胞肺癌预后的影响。方法:回顾性分析1998年2 月至2005年12月间天津医科大学附属肿瘤医院有完整记录的88例局限期小细胞肺癌临床资料，分为颈部预防照射组与无颈部预防照射组。比较两组患者生存率、复发率、远转率、颈部远转率。结果:颈部预防照射组与无颈部预防照射组1 年生存率分别为:82.00% 、84.20%（P=0.785），3 年生存率42.86% 、52.63%（P=0.675），5 年生存率26.67% 、31.42%（P=0.641）；1 年复发率9.09% 、12.50%（P=0.663），3 年复发率39.39% 、32.00%（P=0.562），5 年复发率61.54% 、47.62%（P=0.341）；1 年远转率27.08% 、25.71%（P=0.889），3 年远转率68.18% 、57.14%（P=0.312），5 年远转率75.00% 、70.00%（P=0.642）。 预防照射组与未预防照射组分别有3 例与5例患者2 年内发生颈部淋巴结转移，均伴有其他部位的远处转移灶，该8 例患者均死于别处转移。2 年颈部淋巴结转移率分别为8.33% 与18.52% ，无显著性区别（P=0.230），平均生存期分别为25.67、27.40个月。结论:颈部预防照射未能显著提高患者生存率、降低复发率、远转率，特别是颈部远处转率。颈部预防照射在无锁骨上淋巴结转移的局限期小细胞肺癌治疗中不是必需的放疗靶区。 

Clinical Analysis of Prophylactic Neck Irradiation in Limited Stage Small Cell Lung Cancer Patients without Neck Metastasis

Objective: To analyze the prognosis of prophylactic neck irradiation in limited stage small cell lung cancer (SCLC) patients without neck metastasis compared with non-prophylactic neck irradiation patients. Methods:We retrospec -tively reviewed the clinical records of 88patients with limited stage SCLC from February 1998 to December 2005, which were divided into two groups, the prophylactic neck irradiation group and the non-prophylactic neck irradiation group. The survival rate, recurrence rate, distant metastasis rate and neck metastasis rate were compared between the two groups.Results: The one-year survival rates were82.00% and 84.20% (P=0.785 ) in the prophylactic neck irradiation group and the non-prophylactic neck irradiation group, respectively. The 3-year survival rates were 42.86% and 52.63% (P=0.675 ). The 5-year survival rates were 26.67% and 31.42% (P=0.641 ). The 1-year recurrence rates were 9.09% and 12.50% (P=0.663 ). The 3-year recurrence rates were 39.39% and 32.00% (P=0.562 ). The 5-year recurrence rates were 61.54% and 47.62% (P=0.341 ). The 1-year distant metastasis rates were 27.08% and 25.71% (P=0.889 ). The 3-year metastasis rates were 68.18% and 57.14% (P=0.312 ). The 5-year metastasis rates were 75.00% and 70.00% (P=0.642 ). There were 3 and 5 pa-tients respectively in the prophylactic neck irradiation group and the non-prophylactic neck irradiation group with metastasis in the neck and distant organs 2 years later and all of them died from metastases to other sites. The 2-year neck metasta -sis rates were 8.33% and 18.52% (P=0.230 ), respectively, and the average survival was 25.67and 27.40months. Conclusion: Prognoses in the two groups were not affected by prophylactic neck irradiation. Survival was not significantly im -proved in limited stage SCLC patients without neck metastasis, suggesting prophylactic neck irradiation may be an unnec-essary treatment.