同期放化疗治疗局限期小细胞肺癌的临床观察

目的探讨三维适形放疗或调强放疗同期化疗与序贯放化疗治疗局限期小细胞肺癌的疗效及毒副作用。方法 45例局限期小细胞肺癌患者随机分成三维适形放疗或调强放疗加同步化疗组（同期组,23例）与化疗后再放疗组（序贯组,22例）。同期组在化疗的第l周期开始放疗,序贯组化疗4～6个周期后再进行放疗。两组患者化疗方案均为EP方案,均接受三维适形放疗或调强放疗,1次/天,1.8～2 Gy/次,5次/周,共28～31次,总剂量50.4～62 Gy。照射野包括原发病灶和转移淋巴结及邻近一站淋巴引流区。结果原发病灶总有效率同期组为95.7%,序贯组为86.4%;1～2级急性骨髓抑制发生率同期组为82.6%,3～4级同期组为8.7%,序贯组分别为77.3%、9.1%（P〉0.05）;1～2级放射性食管炎、放射性肺炎发生率同期组分别为78.2%、86.9%,序贯组为72.7%、81.8%（P〉0.05）;两组均无3、4级发生率。同期组和序贯组的12个月、18个月生存率分别为82.6%、69.5%和77.2%、36.3%（P=0.039）,局部复发率分别为8.6%和31.8%（P=0.023）。结论三维适形放疗或调强放疗加同期化疗局限期小细胞肺癌能为绝大多数患者耐受,有较好的近期疗效,是1种安全有效的治疗手段,值得进一步研究。

Concurrent Compared with Sequential Chemoradiotherapy in the Treatment of Patients with Limited Stage Small Cell Lung Cancer

Objective To compare the responses and acute toxicities of concurrent and sequential chemotherapy combined with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in the treatment of limited stage small cell lung cancer(LS-SCLC).Methods From May 2005 to August 2008,45 patients with LS-SCLC were randomized into concurrent group(group A,23 patients) and sequential group(group B,22 patients).All patients in the two groups received the same 3DCRT or IMRT(50.4～62 Gy in 28～31F).The chemotherapy protocol in the two groups was cis-platin combined with VP-16.Patients in the sequential group began radiotherapy after 4～6 cycles of chemotherapy;whereas patients in the concurrent group received radiotherapy in the first week of chemotherapy.The radiotherapy targets included the primary tumor and the involved lymph nodes.Results The overall response rate(CR +PR)of group A and group B was 95.7% and 86.4% for the primary tumor.Grade 1 or 2 hematopoietic toxicity was observed in 82.6% of patients and grade 3 or 4 in 8.7% in group A,in group B was 77.3%、9.1%,P>0.05.grade 1 or 2 acute radiation esophagitis occurred in 78.2% of patients and acute radiation pneumonitis developed in 86.9% in group A,in group B 72.7%、81.8%,P>0.05.Grade 3～4 was not observed in two group.12-and 18-month overall survival rate were 82.6% and 69.5% in group A compared with 77.2% and 36.3% in group B,P=0.039.The locally recurrence rate 8.6% in group and 31.8% in group B,P=0.023.Conclusion Concurrent chemotherapy combined with 3DCRT or IMRT is well tolerated.The short term results of concurrent chemoradiotherapy are better than that of sequential chemoradiotherapy in patients with LS-SCLC.