局限期小细胞肺癌术后预防性全脑照射与化疗的比较

CLINICAL STUDY OF PROPHYLACTIC RADIOTHERAPY OR CHEMOTHERAPY ON LIMITED SMALL CELL LUNG CANCER AFTER OPERATION

目的比较预防性全脑照射或预防性化疗在小细胞肺癌脑转移方面的作用及预后.方法回顾分析1984年6月-1998年6月24例小细胞肺癌根治术后接受脑预防照射的患者.术后病理分期Ⅰ,Ⅱ,ⅢA分别为5,10,9例.预防性全脑照射采用60Co-r线或8MV-X线双侧野对穿照射, 常规分割,5次/周,2Gy/次,中平面剂量为30～40Gy/3～4周.同期根治术后预防性化疗30例作对照.结果脑照射组单独首发脑转移率及总的脑转移率分别为4.2%和12.5%,均明显低于预化组的30.0%和43.3%(χ2=4.309,P=0.038;χ2=4.691,P=0.030),二组比较差异均有统计学意义.脑照射组1,3,5年生存率分别为79.2%、54.2%、45.8%;而预化组分别为76.7%、43.3%、33.3%(χ2=1.04,P=0.308),二组比较差异无统计学意义.预防性全脑照射未出现明显的脑损伤后遗症.结论小细胞肺癌根治术后在减少脑转移发生方面预防性全脑照射优于预防性化疗,有提高生存率趋势.

Objective To evaluate the effect of prophylactic cranial irradiation (PCI) or prophylactic chemotherapy on survival and brain metastasis in patients with limited small-cell lung cancer(SCLC) after operation. Methods 24 patients with limited SCLC after operation were performed prophylactic cranial irradiation(R group)from June 1990 to June 1998, in which there were 18 males and 6 females. The post-operative pathologic stages(Ps) of them in stageⅠ,Ⅱ, Ⅲ were 5,10 and 9, respectively. As a prophylactic cranial irradiation, all patients received 30～40GY in 15～20 fractions of 2 GY/fraction. 30 controls were treated by chemotherapy after operation without PCI (C group). Survival rates were analyzed and compared by life table and Long-Rank, incidence rate of cranial metastases was compared by chi 2 test. Results The incidence rate of isolated first brain metastases and the overall rate of brain metastasis were 4.2% and 12.5% respectively, which were significantly lower than 30.0% and 43.3% in R group (P<0.05). The 1-,3-and5-year survival rate were 79.2%, 54.2%,45.8% in R group and 76.7%, 43.3%, 33.3% in C group(P>0.05). No serious sequela was observed in patients receiving PCI. Conclusion PCI may decrease cranial metastases incidence rate in patients with limited SCLC after operation and is better than prophylactic chemotherapy.