不同放化疗组合方案对广泛期SCLC预后影响

目的 探讨不同放化疗组合方案对广泛期SCLC预后的影响。方法 回顾分析2011—2015年收治的322例广泛期SCLC患者,均接受依托泊苷+顺铂或卡铂标准方案化疗;根据RECIST标准将化疗后疗效分为CR、PR、SD、PD,排除化疗后进展的90例,共入组232例。根据化疗有效后是否行放疗将患者分为放疗组(187例)和无放疗组(45例)。根据放疗的早晚分为早放疗组(化疗≤3个周期接受放疗,65例)和晚放疗组(化疗>3个周期接受放疗,122例)。根据放疗和化疗顺序分为同步放化疗组(45例)和序贯放化疗组(142例)。Kaplan-Meier计算生存率,Logrank检验差异,Cox模型多因素预后分析。结果 中位OS、PFS、LRFS全组分别为13.2、 8.7、14.6个月;无放疗组分别为 8.7、5.6、5.9个月,有放疗组分别为15.0、9.8、19.2个月(P=0.00、0.00、0.00);早放疗组分别15.4、8.0、19.2个月,晚放疗组分别为14.6、10.8、18.1个月(P=0.720、0.426、0.981);同步放化疗组分别为19.4、10.8、19.8个月,序贯放化疗组分别为13.8、9.8、17.8个月(P=0.036、0.656、0.768)。接受放疗患者不良反应较无放疗患者增加(P=0.038),但≥3级严重不良反应相似(P=0.126)。

Effects of different chemoradiotherapy schemes on the prognosis of extensive-stage small-cell lung cancer

Objective To investigate the effects of different chemoradiotherapy (CRT) schemes on the prognosis of extensive-stage small-cell lung cancer (SCLC). Methods A retrospective analysis was performed in 322 patients with extensive-stage SCLC who were admitted to our hospital from 2011 to 2015.All patients received standard EP/CE (etoposide+cisplatin/carboplatin) chemotherapy. According to RECIST criteria, the efficacy of chemotherapy was divided into complete response, partial response, stable disease, and progressive disease (PD). A total of 232 patients without PD after chemotherapy were enrolled as subjects and divided into radiotherapy group (n=187) and non-radiotherapy group (n=45).The patients undergoing radiotherapy were further divided into early radiotherapy group (before 3 cycles of chemotherapy, n=65) and late radiotherapy group (after 3 cycles of chemotherapy, n=122),or concurrent CRT group (n=45) and sequential CRT group (n=142).The survival rates were analyzed using the Kaplan-Meier method. Between-group comparison was made by log-rank test. The Cox regression model was used for multivariate prognostic analysis. Results In all the patients, the median overall survival (OS), progression-free survival (PFS),and local recurrence-free survival (LRFS) time was 13.2,8.7,and 14.6 months, respectively. The non-radiotherapy group had significantly shorter median OS, PFS, and LRFS time than the radiotherapy group (8.7 vs. 15.0 months, P=0.00;5.6 vs. 9.8 months, P=0.00;5.9 vs. 19.2 months, P=0.00).There were no significant differences in median OS, PFS, or LRFS time between the early radiotherapy group and the late radiotherapy group (15.4 vs. 14.6 months, P=0.720;8.0 vs. 10.8 months, P=0.426;19.2 vs. 18.1 months, P=0.981).The concurrent CRT group had significantly longer median OS time than the sequential CRT group (19.4 vs. 13.8 months, P=0.036),while there were no significant differences in median PFS or LRFS time between the two groups (10.8 vs. 9.8 months, P=0.656;19.8 vs. 17.8 months, P=0.768).Generally, patients undergoing radiotherapy had increased incidence rates of adverse reactions than those without radiotherapy (P=0.038).However, the incidence rates of grade ≥3 adverse reactions were similar between the two groups (P=0.126). Conclusions In the treatment of extensive-stage SCLC, thoracic radiotherapy improves the treatment outcomes without increasing the incidence rates of severe adverse reactions. When to receive radiotherapy has nothing to do with the prognosis. Concurrent CRT may further improve the treatment outcomes, which still needs further studies.