局限期小细胞肺癌化疗联合加速超分割放疗疗效初步分析

Efficacy of Chemotherapy Combined Hyperfractionated Accelerated Radiotherapy on Limited Small Cell Lung Cancer

背景与目的:局限期小细胞肺癌(small cell lung cancer,SCLC)对放疗和化疗均敏感。放疗可提高局限期SCLC患者总生存率,降低局部复发率。本研究总结在化疗基础上应用加速超分割放射治疗(hyperfractionated accelerated radiotherapy,HART)对局限期SCLC的疗效,评价相关治疗毒性,归纳治疗失败方式。方法:55例局限期SCLC患者经过EP方案诱导化疗,放疗后再以EP方案巩固化疗,完全缓解(complete remission,CR)者行预防性全脑照射(prophylactic cranial irradiation,PCI)。治疗结束后对患者进行随访,并评价其疗效及毒副作用。结果:55例患者放化疗结束时总有效率(CR+PR)为87.3%。1、3、5年总生存率分别为79.1%、40.3%、16.1%,中位生存时间18.7个月。Ⅲ度和Ⅳ度血液学毒性分别为23例(41.8%)和16例(29.1%);Ⅰ度和Ⅱ度急性放射性肺炎分别为21例(38.2%)和2例(3.6%),Ⅰ度和Ⅱ度放射性食管炎分别为29例(52.7%)和12例(21.8%),未发生Ⅲ～Ⅳ度非血液学毒性。11例(20.0%)患者出现Ⅰ度肺纤维化,5例(9.1%)为Ⅱ度。2例(3.6%)发生Ⅰ度后期食管损伤。16例(29.1%)局部/区域复发,21例(38.2%)发生远处转移。结论:EP方案化疗合并HART治疗局限期SCLC毒性轻至中度,患者可以耐受。局部复发和远处转移为主要治疗失败原因。

BACKGROUND ＆ OBJECTIVE： Limited small cell lung cancer （SCLC） is sensitive to both radiotherapy and chemotherapy. Radiotherapy can enhance survival rate and reduce the local/regional recurrence rate of limited SCLC. This study was to analyze the efficacy of chemotherapy combined hyperfractionated accelerated radiotherapy （HART） on limited SCLC, observe treatment-related adverse events and summarize the treatment failure patterns. METHODS= A total of 55 limited SCLC patients were treated with EP regimen as induction chemotherapy, then received radiotherapy, followed with EP regimen as consolidation chemotherapy. Prophylactic cranial irradiation （PCI） was given to those patients who had achieved complete remission （CR） after chemoradiotherapy. As treatment was completed, patients were followed up, the efficacy and toxicities were evaluated. RESULTS. At the end of chemoradiotherapy, the overall response rate was 87.3%. The 1-, 3-, and 5-year overall survival rates were 79.1%, 40.3% and 16.1%, respectively, with the median survival time of 18.7 months. Grade III and IV hematologic toxicities were observed in 23 （41.8%） and 16 （29.1%） patients, respectively. Grade I and II radiationinduced pneumonitis occurred in 21 （38.2%） and 2 （3.6%） patients, respectively. Grade I and II radiation-induced esophagitis occurred in 29 （52.7%） and 12 （21.8%） patients, respectively. No grade Ill/IV nonhematologic toxicity was observed. Grade I and II pulmonary fibrosis occurred in 11 （20.0%） and 5 （9.1%） patients, respectively. Grade I esophageal stricture was observed in 2 （3.6%） patients. Of the 55 patients, 16 （29.1%） had local/regional recurrence, 21 （38.2%） suffered from distant metastasis. CONCLUSIONS= The toxicities of EP regimen chemotherapy combined with HART are mild to moderate and are tolerable by patients. Local/regional recurrence and distant metastasis are the main reasons of treatment failure.