234例局限期小细胞肺癌综合治疗结果分析

A Retrospective Study for the Limited-stage Small Cell Lung Cancer Patients with Combined Modality Treatment:An Analysis of 234 Patients

目的回顾性分析局限期小细胞肺癌的治疗情况,并评价不同治疗方式的疗效和预后因素。方法经病理和组织学证实的局限期小细胞肺癌234例,行化疗或化放疗的综合治疗,其中单纯化疗组22例,化疗+放疗组39例,化疗+放疗+化疗组173例。化疗以CE(PE)、CAP、CAV方案为主,一般疗程为4～6周期。放疗采用6MV-X线直线加速器,照射范围包括原发灶、肺门及同侧纵隔。先行前后对穿照射4周,然后改斜野避开脊髓补量2周,使总量达56～60Gy/5～6周。结果全组总的中位生存时间为19个月,1年生存率为76.5%,2年生存率为38.2%,3年生存率为25.3%,5年生存率为15.6%。化疗+放疗+化疗组的生存率明显高于化疗+放疗组和单纯化疗组,具有显著差异(P<0.001)。治疗方式和临床分期对预后产生明显影响(分别为P<0.001,P=0.001)。结论化疗+放疗+化疗的综合治疗对局限期小细胞肺癌的治疗取得较好的效果,临床分期及治疗方式对预后产生明显影响。

Objective To evaluate the treatment effects of chemotherapy comparing with chemotherapy and radiotherapy in the limited - stage small cell lung cancer （SCLC）. Methods 234 patients were eyto - pathologically diagnosed and staged as limited small cell lung cancer. The patients were treated with combined chemotherapy and radiotherapy, in which 22 cases were treated by alone chemothera- py （C） , 39 patients by chemotherapy plus radiotherapy（ C ＋ R） , and 173 cases by combined chemotherapy and radiotherapy ＋ chemotherapy （C ＋ R ＋ C）. The chemotherapy regimen included CE （or PE） , CAP or CAV for 4 -6 cycles. Irradiation treatment covering the primary tumor, the ipsilateral hilar nodes and mediastinum was delivered once daily with 6 megavoltage X - ray beam to a median irradiation does of 56 Gy being given in5-6 weeks. Results The 1 -, 2-, 3-, and S - year overall survival rates were 76. 5% , 38.2%, 25.3% , 15.6% respectively,and the median survival time （MST） was 19 months. There was a significantly difference on the survival rate between C ＋ R ＋ C group and C ＋ R group or C group （P 〈 0.001 ）. Clincal stage and treatment model were the affective factor of prognosis（P = 0. 001, P 〈0. 001 ）. Conclusion For limited stage SCLC, combined chemotherapy and radiotherapy ＋ chemotherapy could get good local effect and OS. The stage and treatment model should affect the prognosis.