化疗联合立体定向放疗治疗小细胞肺癌的临床研究

Clinical study on the treatment of small cell lung cancer with chemotherapy and stereotactic radiation therapy

目的探讨以化疗为主同期立体定向放射治疗小细胞肺癌的临床疗效。方法选择26例入本院治疗的小细胞肺癌患者,采取同期放化疗治疗。化疗方案:EP为主方案,治疗周期4～6周期。放疗采取SRT,治疗剂量3.0～4.5GY,每周6次,中位治疗剂量38.5GY。放疗介入时间:化疗开始1～2周期后,下一周期化疗前。放疗靶区:照射原发灶及明确转移灶,淋巴引流区不做预防照射。中位随访时间为24个月。结果 (1)全组患者CR率为46.2%,PR率为38.5%,SD率为15.3%,总治疗有效率为84.6%,中位生存期为17个月,1年及2年生存率分别为80.1%及38.5%。1年及2年局部无进展生存率分别为98.1%及94.2%;(2)2级急性放射肺损伤的发生率为3.8%,2级晚期放射性肺损伤的发生率为7.7%,2级急性放射性食道损伤的发生率为11.5%,2级急性血液学毒性的发生率为7.7%。结论化疗联合SRT治疗小细胞肺癌是可行的,患者的近期疗效可,毒副反应的发生率较低,值得临床应用和推广。

Objective To investigate the clinical efficacy of the treatment with chemotherapy and stereotactic radiation therapy on small cell lung cancer.Method 26 patients with small cell lung cancer admitted in our hospital were given chemotherapy and stereotactic radiation therapy at the same term.Chemotherapy：EP-based programs for 4～6 cycles.Stereotactic radiation therapy,dose 3.0～4.5GY,6 times per week,median dose 38.5 GY.Radiotherapy intervention time：after 1～2 cycles of chemotherapy and before the next cycle of chemotherapy.Radiotherapy target：primary tumor and clear metastases.No preventing irradiation to lymphatic drainage district.The median follow-up time was 24 months.Results （1）The CR rate was 46.2%,PR rate was 38.5%,SD rate was 15.3%,total effective rate was 84.6%,the median survival time was 17 months,1-year overall survival（OS） were 80.1% and 2-year OS were 38.5%.The 1-and 2-year local progression free survival（LPFS） were 98.1% and 94.2% respectively.（2）The incidence rate of grade 2 acute radiation pneumonitis was 3.8%,and of grade 2 late radiadtion pneumofibrosis was 7.7%.The incidence rate of grade 2 acute radiation esophagitis was 11.5% and of grade 2 acute hematologic toxicity was 7.7%.Conclusion The treatment of small cell lung cancer with chemotherapy and stereotactic radiation therapy was feasible and worth being applied and generalized in clinics for its good curative effect and low incidence of toxic effects.