应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC研究

Clinical efficacy of radical intensity-modulated radiotherapy combined with reduction in dose of prophylactic irradiation in treatment of stage Ⅲ small cell lung cancer

目的 分析应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC的疗效和不良反应.方法 回顾分析2010-2012年间收治的40例Ⅲ期SCLC患者资料.PGTV总剂量60 Gy分30次,PTV总剂量54 Gy分30次.全部接受了铂类联合依托泊苷或替尼泊苷方案的诱导化疗,31例辅助化疗,22例同期放化疗.17例患者接受了脑预防照射（25 Gy分10次）.采用RECIST 1.0和CTCAE 4.0标准分别评价近期疗效和不良反应.采用Kaplan-Meier法计算生存率.结果 近期有效率98％.随访率100％,随访时间满2年者22例.1、2年OS分别为84％、48％,LRFS分别为89％、85％,PFS分别为61％、41％.治疗相关性肺炎发生率0～1级65％、2级25％、3级5％、5级5％,治疗相关性食管炎发生率0～1级53％、2级43％、3级5％.结论 初步结果显示根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC是安全有效的,值得进一步大样本前瞻性随机分组研究.

Objective To evaluate the clinical efficacy and toxicities of radical intensity-modulated radiotherapy （IMRT） combined with reduction in dose of prophylactic irradiation in the treatment of stage m small cell lung cancer （SCLC）. Methods A retrospective analysis was performed on the clinical data of 40 patients with stage III SCLC who were admitted from January 2010 to August 2012. The prescribed dose was 60 Gy in 30 fractions to the primary gross tumor volume and was 54 Gy in 30 fractions to the planning target volume. All patients received induction chemotherapy, 31 patients received adjuvant chemotherapy, and 22 patients received concurrent chemoradiotherapy ; the platinum-based chemotherapy combined with etoposide or teniposide was adopted. Prophylactic cranial irradiation （25 Gy in 10 fractions ） was administered to 17 patients. The short-term tumor response was evaluated by RECIST 1.0, and radiation-related toxicities were assessed by CTCAE 4. 0. Overall survival （ OS）, local recurrence-free survival （ LRFS）, and progression- free survival （PFS） were calculated by Kaplan-Meier method. Results The short-term tumor response rate was 98%. The follow-up rate was 100%. Twenty-two patients were followed up for at least 2 years. The 1- and 2-year OS rates were 84% and 48% , respectively;the LRFS rates were 89% and 85% , respectively; the PFS rates were 61% and 41% , respectively. Grade 0--1 radiation-related pneumonia was observed in 65%（26/40） of all patients, grade 2 in 25% （10/40）, grade 3 in 5% （2/40）, and grade 5 in 5% （2/40）. Grade 0--1 radiation-related esophagitis was observed in 53% （21/40） of all patients, grade 2 in 43 % （ 17/40）, and grade 3 in 5 % （2/40）. Conclusions Preliminary results from this study suggested that IMRT combined with reduction in dose of prophylactic irradiation is safe and effective in patients with stage ⅢI SCLC and is worth further evaluation in a large, prospective, randomized study.