调强放疗联合化疗治疗局限期小细胞肺癌近期疗效分析

Recent effects of chemotherapy plus intensity-modulated radiotherapy for limited small cell lung cancer

目的:分析化疗联合调强适形放疗治疗局限期小细胞肺癌(SCLC)的近期疗效和放射损伤情况。方法:42例局限期SCLC采用放化疗综合治疗,放疗常规分割,单次剂量2Gy,每周5次,中位总剂量58Gy。化疗采用卡铂或顺铂+VP 16为主的方案,4-6个周期。中位随访32个月。结果:全组患者CR为35.7%(15/42),PR为57.1%(24/42),SD为7.1%(3/42),有效率为92.8%。1年总生存率(OS)为75.8%,2年为37.5%,3年为21.5%,中位生存时间为23个月。2级急性放射性肺损伤为4.8%(2/42),2级晚期放射性肺损伤为7.1%(3/42),2级急性放射性食管损伤11.9%(5/42),2级血液学毒性为11.9%(5/42)。结论:化疗联合IMRT用于局限期SCLC治疗,能获得较好的近期疗效和2年生存率,放射损伤在可接受范围,放疗剂量、照射范围值得进一步研究。

Objective：To evaluate the recent effects and radiation injury after chemotherapy plus intensity-modulated radiotherapy for limited small cell lung cancer（SCLC）.Menthods：Forty two SCLC patients were treated from June 2004 to March 2006 by chemotherapy combined with IMRT.Radiotherapy treatment was divided at 2Gy/fraction,5 fractions per week with a median total dose of 58Gy.Chemotherapy consisted of 4-6 cycles of etoposide and cisplatin or carboplatin.The median follow-up time was 32 months.Results：The overall response rate was 92.8%,with a complete remission rate 35.7%（15/42）,partial remission rate of 57.1%（24/42） while the 1 and 2 and 3 years overall survival was 75.8%,37.5% and 21.5% respectively.The median survival time was 23 months.4.8% of these patients developed grade 2 acute radiation pneumonitis,7.1% developed grade 2 late injury,11.9% developed grade 2 acute radiation esophagitis and 11.9% developed grade 2 acute radiation hematologic toxicity.Conclusion：Chemotherapy plus IMRT is feasible in the treatment of SCLC with high response rate and acceptable complications.Further observation is needed to evaluate long-term survival.