局限期小细胞肺癌放化疗后局部区域复发模式分析

目的 分析精确放疗技术下局限期小细胞肺癌(SCLC)调强放化疗后局部区域复发模式、复发部位与放化疗关系及影响因素。方法 回顾分析中国医学科学院肿瘤医院于2006-2014年治疗的局限期SCLC患者482例,其中125例治疗局部区域复发,采用Kaplan-Meier生存分析,Logrank法检验差异和单因素分析影响因素,Logistic回归法多因素分析影响因素。结果 全组复发患者的1、2、5年生存率分别为92.0%、46.4%、14.7%,中位生存期23.40个月。中位进展时间12.96个月,复发后的中位生存期为11.50个月,1、2、5年生存率分别为45.0%、23.0%、10.0%。原发灶复发67例(53.6%)、区域淋巴结复发21例(16.8%)、原发灶+区域淋巴结复发28例(22.4%)、对侧纵隔或锁骨上淋巴结复发9例(7.2%),其中位生存期分别为23.96、24.76、23.23、18.66个月,2年生存率分别为49%、52%、46%、11%(P=0.000、0.004、0.008)。6例(4.0%)患者靶区外孤立淋巴结复发,其中5例位于锁骨上区域,1例(0.8%)野外孤立淋巴结复发。结论 局限期SCLC放化疗后局部失败部位主要为肺原发灶,更好的分割剂量和靶区范围需要进一步的临床探索。

Analysis of local recurrence pattern for limited stage small cell lung cancer after IMRT plus chemotherapy

Objective To investigate localized regional recurrence after chemotherapy and chest radiotherapy in limited stage small cell lung cancer (LS-SCLC),and explore the relationship between recurrence location and radiotherapy and chemotherapy and its influencing factors.Methods From 2006 to 2014,pathological LS-SCLC treated in CAMS,125 patients had local recurrence,Kaplan-Meier statistical method was used to analyze the survival rate and PFS of each recurrence site. Log-rank was used to compare the survival rate of each group. Univariate analysis includes Chi-squareand t-test for the factors for the recurrence site. Multivariate analysis using Logistic regression.Results The 1-,2-and 5-year overall survival rates were 92.0%,46.4% and 14.7%,respectively. The median progression time was 12.96 months,The median survival time after progression was 11.5 months,and the 1-,2-,and 5-year overall survival rates were 45.0%,23.0%,and 10.0%,respectively. The recurrence sites include intrapulmonary recurrence (67 patients),regional lymph nodes (21 patients),simultaneous intrapulmonary and regional lymph nodes (28 patients), and contralateral or supraclavicular lymph nodes (9 patients). The median survival time were 23.96 months,24.76 months,23.23 months,and 18.66 months,and the 2-year survival rates were 49%,52%,46%,and11%,respectively (P=0.000,0.004,0.008). In 6 patients (4.0%),5 patients were located in the supraclavicular region,and 1 patient (0.8%) in the field.Conclusions For LS-SCLC undergoing IMRT and chemotherapy,the local failure location is mainly located in the pulmonary,and further treatment of the split dose and targets requires further clinical exploration.