局限期小细胞肺癌调强适形放疗同步化疗的临床研究

Three-dimensional conformal radiotherapy or intensity-modulated radiotherapy combined with concurrent sequential chemotherapy for limited stage small cell lung cancer

目的:观察分析调强适形放疗同步化疗与序贯放化疗治疗局限期小细胞肺癌的疗效、毒副反应及生活质量。方法:45例局限期小细胞肺癌患者被随机分成精确放疗加同步化疗组(同步组,23例)与化疗后再放疗组(序贯组,22例)。同步组在化疗的第1个周期开始放疗,序贯组化疗4～6个周期后再进行放疗。两组患者化疗方案均为EP方案,均接受精确放疗,1次/d,(1.8～2.0)Gy/次,5次/周,共28～31次,总剂量50.4～62.0Gy。照射野包括原发病灶和转移淋巴结。结果:同步组和序贯组原发病灶总有效率为95%和86%;12和18个月生存率分别为84%、69%和76%、34%。两组患者的毒副反应均以急性骨髓抑制、放射性食管炎及放射性肺炎为主。同步组Ⅰ～Ⅱ级放射性食管炎和放射性肺炎发生率分别为78%和86%,与序贯组的73%和81%近似。Ⅲ～Ⅳ级急性骨髓抑制发生率同步组和序贯组分别为8%、9%。生活质量QOL评分同步组和序贯组治疗前后差异无统计学意义。结论:调强适形放疗同步化疗局限期小细胞肺癌有较好的疗效,毒副反应为绝大多数患者耐受且生活质量无明显下降,但值得进一步研究。

OBJECTIVE： To evaluate the responses and acute toxicities and life quality of concurrent sequential radiochemother apy with three-dimensional conformal radiotherapy or intensity- modulated radiotherapy for limited stage small cell lung cancer （LS-SCLC）. METHODS： Totally 45 patients with LS-SCLC were randomized into concurrent group（group A, 23 patients ） and sequential group （group B,22 patients ）. All patients in these two groups received 3D-CRT and IMRT（1.8--2.0 Gy/f, 5 times every week, totally, 50.4-62.0 Gy in 28-31 F） and 4-6 cycles of sequential chemotherapy by EP regimen. The radiotherapy targets were the primary tumor and the involved lymph nodes. 3D- CRT and IMRT were 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 95% and 86% for the primary tumor. The 12-and 18 month overall survival rate were 84%, 69% and 76%, 34 %. Grade Ⅰ or Ⅱ acute radiation esophagitis and pneumonitis was observed in 78% and 86% of patients in group A compared with 73% and 81% in group B. Grade Ill IV acute hematopoietic toxicity was observed in 8% of patients in group A and 9% in group B. Life quality was no statistically significant differences between the two groups. CONCLUSION： 3D-CRT and IMRT with current sequential chemotherapy is effective for LS-SCLC with the side effects being tolerable and quality of life being not falling.