三维适形放射治疗联合化疗治疗局限期小细胞肺癌的疗效分析

目的 回顾性分析85例局限期小细胞肺癌三维适形放疗(3D-CRT)联合化疗疗效及生存率,探讨局限期小细胞肺癌的放疗方法。方法 2004年3月至2008年6月经病理或细胞学证实,且进行4个及以上周期化疗联合放疗的局限期小细胞肺癌85例,采用基于CT定位的累及野放疗, 6~10 MV X射线,剂量为46~66 Gy,中位剂量50 Gy,1次/d,5次/周,5~7周。结果 全组患者完全缓解率36.5%,部分缓解率52.9%,稳定率10.6%;有效率89.4%。全组患者1、2、3年总生存率分别为65.9%、33.8%、15.9%,总中位生存时间18个月。59例患者有治疗失败原因记录,局部复发9例占15.2%,局部复发+远处转移21例占35.6%,远处转移29例占49.2%。结论 局限期小细胞肺癌三维适形技术累及野照射疗效较好,需进一步扩大病例数。

Therapeutic effect of three-dimensional conformal involved-field radiotherapy combined with chemotherapy on limited disease stage small cell lung cancer

Objective To analyze the therapeutic effect of three-dimensional conformal involved-field radiotherapy (3D-CRT)combined with chemotherapy on limited disease stage small cell lung cancer (LD-SCLC). Methods The clinical data of 85 patients of LD-SCLC treated with 3D-CRT at the dose of 2 Gy/fraction, 5 fractions per week for 5-7 weeks, with the median dose of 50 Gy (46-66 Gy), combined with 4-8 cycles chemotherapy, 64 males and 21 females, aged 29-76,were collected and analyzed. Results The complete remission rate, partial remission rate, stability rate, and total effective rate were 36.5% , 52.9% , 10.6% , and 89.4% , respectively. The median survival time was 18 months,with the 1-, 2-, and 3-year overall survival rates of 65.9%, 33.8%, and 15.9%, respectively. The local recurrence rate, distant metastasis rate, and local recurrence+distant metastasis rate were 15.2% (9/85), 49.2% (29/85), and 35.6% (21/85), respectively. Body weight, response to therapy,cycles for chemotherapy, and concurrent chemo-radiotherapy were all independent prognostic factors for LD-SCLC. Cox multivariable regression was used to analyze the prognostic factors. Conclusions Involved-field radiotherapy is effective for LD-SCLC. Distance metastasis is the main cause of treatment failure.