三维适形放疗同步化疗局限期小细胞肺癌的临床研究

Three-dimensional conformal radiation therapy and concurrent sequential chemotherapy for limited stage small cell lung cancers

目的比较三维适形放疗同步化疗和序贯化放疗治疗局限期小细胞肺癌的疗效及副作用。方法65例局限期小细胞肺癌患者被随机分成三维适形放疗加同步化疗组（同步组,33例）和化疗后再放疗组（序贯组,32例）。同步组在化疗的第1周期开始放疗,序贯组化疗4～6个周期后再进行放疗。两组患者均接受三维适形放疗,1次/d,2 Gy/次,5次/周,共25～32次,总剂量50～62 Gy。照射野包括原发病灶和转移淋巴结。化疗方案均为EP方案。结果同步组和序贯组的近期有效率分别为100%和91%,其中CR率分别为33%和9%（P=0．006）。同步组和序贯组的1、2年生存率分别为80%、66%和73%、33%（P=0．041）。同步组和序贯组局部复发率分别为9%和31%,同步组低于序贯组（P=0．026）。两组患者的毒副反应均以白细胞减少、放射性食管炎和放射性肺炎为主。同步组1～2级放射性食管炎、放射性肺炎发生率分别为79%、82%与序贯组的75%、78%相仿（P＞0．05）。无3、4级放射性食管炎和放射性肺炎。3～4级血液反应发生率同步组和序贯组分别为9%和13%（P＞0．05）。结论三维适形放疗加同步化疗局限期小细胞肺癌有较好疗效,是一种安全有效的治疗手段,值得进一步研究。

Objective To compare the treatment effects and toxicities of three-dimensional conforreal radiation therapy（3DCRT）and concurrent sequential chemotherapy to limited stage small cell lung cancer（LS-SCLC）. Methods From March 2003 to August 2006,65 patients with LS-SCLC were randomized into concurrent group（ group A ,33 patients）and sequential group（ group B ,32 patients）. All patients in these two groups received 3DCRT（50-62 Gy in 35-45 days）and 4-6 cycles of sequential chemotherapy（ carboplatin and etoposide）. The radiotherapy targets were the primary tumor and the involved lymph nodes. 3DCRT was started in the first cycle of chemotherapy in group A. Patients in group B were treated with radiation ＇after 4- 6 cycles of chemotherapy. Results The overall response rate of group A and group B was 100% and 9! %. The complete response（CR） rate of the two groups was 33% and 9% （P = 0. 006）. The survival rate was 80% at 1 year, 66% at 2 years in group A compared with 73% and 33% in group B, P = 0. 041. Grade 1-2 acute radiation esophagitis and pneumonitis were observed in 79% and 82% of patients in group A compared with 75% and 78% in group B （P 〉 0.05 ）. Grade 3-4 acute leucopenia rate was observed in 9% of patients in group A and 13% in group B （P 〉 0.05）. Conclusions Three-dimensional conformal radiotherapy with current sequential chemotherapy is effective for limited stage small cell lung cancer with the side effects being tolerable.