327例广泛期小细胞肺癌综合治疗的疗效分析

目的比较广泛期小细胞肺癌（ES-SCLC）化疗后加或不加胸部放疗的疗效，为ES-SCLC患者的综合治疗提供依据。方法回顾性分析2007年至2012年接受化疗±胸部放疗的327例初治ES-SCLC患者资料。其中，130例（39.8%）患者进行了胸部放疗（化放疗组），197例（60.2%）接受单纯化疗（单纯化疗组）。化疗方案以EP（依托泊苷+顺铂）、CE（卡铂+依托泊苷）方案为主，胸部放疗采用调强放射治疗，放疗剂量为32~67 Gy。采用Kaplan-Meier法计算生存率，Log Rank法进行单因素预后分析，Cox回归模型进行多因素预后分析。结果全组随访率为95.1%。化疗后达完全缓解（CR）、部分缓解（PR）、稳定（SD）者分别占2.5%、76.1%和21.4%。全组中位生存时间为13.7个月，中位无进展生存时间（PFS）为9.3个月。化放疗组的生存时间和PFS均显著提高，中位生存时间为20.0个月，中位PFS为10.8个月，而单纯化疗组分别为11.4个月和7.7个月。化放疗组的2年、3年、5年总生存率（OS）分别为42.5%、27.8%、18.8%，而单纯化疗组分别为11.6%、6.6%、3.5%（χ2=50.730，P < 0.001）。亚组分析结果显示，按初诊脑转移状态和化疗疗效（CR+PR、SD）分层，胸部放疗均能显著提高OS，但不能延长初诊有脑转移的患者的PFS。胸部放疗能显著降低化放疗组的局部区域复发率至19.2%，而单纯化疗组为75.6%（χ2=100.080，P < 0.001）。结论对于化疗后无进展的ES-SCLC，胸部放疗可提高局部控制率，延长患者的总生存时间和PFS。

Clinical outcomes of 327 patients with extensive-stage small cell lung cancer treated with chemotherapy combined with or without thoracic radiation therapy

ObjectiveTo evaluate the influence of thoracic radiation therapy (TRT) on the survival of patients with extensive-stage small cell lung cancer (ES-SCLC) after chemotherapy.MethodsA retrospective review was conducted on patients with ES-SCLC who received chemotherapy±TRT from January 2007 to December 2012. Most patients received initial chemotherapy with carboplatin plus etoposide or chemotherapy with cisplatin plus etoposide. A total of 130 cases of patients (39.8%) underwent TRT. TRT was performed through intensive modified radiotherapy. The median thoracic radiation dose was 56 Gy(32-67 Gy), with 1.8-2.3 Gy per fractions. The Kaplan-Meier, Log Rank test, and Cox regression were used for survival analysis and identification of prognostic factors. Statistically significant difference was set at P < 0.05.ResultsOverall, 327 consecutive patients were enrolled. The follow-up rate was 95.1%. Patients reaching complete response(CR), partial response(PR), and stable disease(SD) after chemotherapy accounted for 2.4%, 76.1%, and 21.4%, respectively. The median follow-up time for survival patients was 69 months. The median overall survival (OS) of the whole group was 13.7 months, and the median progression-free survival(PFS) was 9.3 months. These results showed that TRT significantly improved the OS and PFS of patients. The median OS was 20.0 and 11.4 months in the TRT and non-TRT groups, respectively. Correspondingly, their median PFS was 10.8 and 7.7 months, respectively. The two-, three-, and five-year OS were 42.5%, 27.8%, and 18.8% in the TRT group and 11.6%, 6.6%, and 3.5% in the non-TRT group, respectively(χ2=50.730, P < 0.001). Stratified analysis indicated that TRT can increase the OS in all the subgroups when the participants were divided according to different brain metastasis statuses and responses after chemotherapy(CR+PR, SD). However, TRT cannot improve the PFS of patients with brain metastasis. TRT can significantly decrease the locoregional recurrence rate to 19.2% and that of the non-TRT group was approximately 75.6%(χ2=100.080, P < 0.001).ConclusionTRT can significantly improve the OS and PFS and decrease the locoregional recurrence rate in all patients with ES-SCLC with different brain metastasis statuses and responses after chemotherapy.