胸部3DCRT在广泛期SCLC中的应用研究

目的 评价胸部3DCRT在广泛期SCLC中的价值。方法 选择2004—2009年间收治的171例广泛期SCLC患者纳入研究,其中86例接受胸部3DCRT和全身化疗,85例只接受全身化疗。放疗采用超分割(1.5 Gy/次,2 次/d)或常规分割(2.0 Gy/次,1 次/d)方式,总量40~62 Gy。化疗方案为铂类联合依托泊甙。生存计算采用Kaplan-Meier法并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果 随访率为100%。全组中位OS期、2年OS率、5年OS率全组分别为15个月、31.5%、2.4%,放疗组的分别为18个月、35.3%、2.4%,化疗组的分别为12个月、14.5%、2.4%(P=0.023)。全组中位PFS期、1年PFS率、2年PFS率全组分别为8个月、27.5%、2.4%,放疗组的分别为9个月、35.4%、6.0%,化疗组的分别为6个月、20.5%、6.0%(P=0.004)。放疗组中超分割总量45 Gy的22例患者中位PFS期11个月,常规分割总量60 Gy的26例患者中位PFS期9个月(P=0.037)。多因素分析显示3DCRT、4周期以上化疗是预后有利因素(P=0.008、0.001)。结论 胸部放疗能改善广泛期SCLC患者OS和PFS,总量45 Gy超分割放疗较佳。胸部放疗和4周期以上化疗对OS是独立的预后有利因素。

Role of thoracic conformal radiotherapy in patients with extensive-stage small cell lung cancer

Objective To evaluate the role of thoracic three-dimensional conformal radiotherapy (3DCRT) in patients with extensive-stage small cell lung cancer (ES-SCLC). Methods A total of 171 patients with ES-SCLC admitted from 2004 to 2009 were included in the study. Eighty-six patients received thoracic 3DCRT and systemic chemotherapy (CT), while 85 patients received systemic CT alone. 3DCRT was delivered at 1.5 Gy/fraction twice daily or 2.0 Gy/fraction once daily, with a total dose ranging from 40 to 62 Gy. The CT regimen consisted of carboplatin/cisplatin and etoposide. The survival time and survival rate were calculated by the Kaplan-Meier method, and the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The follow-up rate was 100%. The median overall survival (OS) time and the 2- and 5-year OS rates were 15 months, 31.5%, and 2.4%, respectively, for all patients;they were 18 months, 35.3%, and 2.4%, respectively, for the CT/3DCRT group, versus 12 months, 14.5%, and 2.4% for the CT group (P=0.023). The median progression-free survival (PFS) time and the 1-and 2-year PFS rates were 8 months, 27.5%, and 2.4%, respectively, for all patients;they were 9 months, 35.4%, and 6.0%, respectively, for the CT/3DCRT group, versus 6 months, 20.5%, and 6.0% for the CT group (P=0.004). In the CT/3DCRT group, the 22 patients who received 45 Gy at 1.5 Gy/fraction twice daily had a median PFS time of 11 months, versus 9 months for the 26 patients who received 60 Gy at 2.0 Gy/fraction once daily (P=0.037). Multivariate analysis revealed that receiving ≥4 cycles of CT (P=0.001) and 3DCRT (P=0.008) were favorable prognostic factors for OS. Conclusions Thoracic 3DCRT can improve the OS and PFS in patients with ED-SCLC, and it has good efficacy when delivered with a total dose of 45 Gy at 1.5 Gy/fraction twice daily. Thoracic 3DCRT and receiving ≥4 cycles of CT are independent favorable prognostic factors for OS.