广泛期SCLC不同放疗分割方式疗效比较

目的 评价不同放疗分割方式与广泛期SCLC患者LC与OS相关性,以明确不同分割方式与预后关系。方法 2010—2015年间初治的110例广泛期SCLC患者接受放化疗,根据放疗剂量分为大分割组31例(30~45 Gy分10~15次)与常规分割组79例(54~60 Gy分27~30次)。90.9%患者临床分期为Ⅳ期。21例患者伴有脑转移。39例行PCI。Kaplan-Meier法计算生存率并Logrank法检验,组间分类数据行χ²检验。结果 全组2年样本量为85例,全组OS、PFS、LC率分别为27.7%、17.5%、38.9%。大分割组与常规分割组的2年OS分别为35%与26%(P=0.886), 2年PFS分别为18%与16%(P=0.560), 2年LC率分别为67%和36%(P=0.159)。PCI与否的2年OS分别为44%和18%(P=0.044)。全组共84例患者治疗失败,其中局部复发11例、远处转移41例、局部复发+远处转移32例。结论 大分割放疗与常规分割放疗疗效相似,但照射时间明显缩短,大分割放疗需要进一步研究。

Comparison of efficacy of different fractionation schedules in radiotherapy for extensive-stage small cell lung cancer

Objective To evaluate the correlation of different fractionation schedules in radiotherapy with the local control (LC) and overall survival (OS) rates in patients with extensive-stage small cell lung cancer (ES-SCLC), and to figure out the relationship between different fractionation schedules in radiotherapy and the prognosis of ES-SCLC. Methods One hundred and ten patients newly diagnosed with ES-SCLC from February 2010 to March 2015 received chemoradiotherapy. According to the radiation dose, all patients were divided into hypo-fractionation group (30-45 Gy/3 Gy/10-15 f, n=31) and conventional fractionation group (54-60 Gy/1.8-2.0 Gy/27-30 f, n=79). In all patients, 90.9% had stage Ⅳ SCLC;21 patients had brain metastasis;39 patients were treated with prophylactic cranial irradiation (PCI). The Kaplan-Meier method was used to calculate the survival time and log-rank test was used for between-group comparison. Between-group comparison of categorical data was made by χ² test. Results The number of patients followed-up were 85 at 2-years. In all patients, the 2-year OS, progression-free survival (PFS), and LC rates were 27.7%, 17.5%, and 38.9%, respectively. The hypo-fractionation group had similar prognosis to the conventional fractionation group. There were no significant differences in the 2-year OS, PFS, and LC rates between the two groups (35% vs. 26%, P=0.886;18% vs. 16%, P=0.560;67% vs. 36%, P=0.159). There was also no significant difference in the 2-year OS rate between patients treated with and without PCI (44% vs. 18%, P=0.044). In 84 patients with treatment failure, 11 had local recurrence, 41 had distant metastasis, and 32 had local recurrence plus distant metastasis. Conclusions The hypofractionated radiotherapy has similar efficacy but substantially shortened radiation time compared with conventionally fractionated radiotherapy. The palliative hypofractionated radiotherapy requires further study for ES-SCLC.