老年局限期小细胞肺癌应慎用同期放化疗

Concurrent chemoradiotherapy should be used with caution in elderly patients

目的 探讨同期放化疗在老年局限期小细胞肺癌治疗中的价值.方法 回顾分析2006-2011年本院行根治性胸部放疗的168例局限期小细胞肺癌患者临床资料,将年龄≥65岁者定义为老年组（53例）,＜ 65岁者定义为非老年组（115例）,对比不同治疗模式在老年和非老年患者的疗效及不良反应差异.结果 随访率为95.2％（两组分别失访4例）.全组中位OS为24.6个月,中位PFS期为15.4个月.老年患者同期放化疗和序贯放化疗的中位OS分别为15.9个月和24.6个月（P =0.013）,3、4级血液学不良反应发生率分别为13.3％和2.6％ （P=0.170）;非老年患者同期放化疗和序贯放化疗的中位OS分别为39.6个月和24.5个月（P=0.018）,不良反应发生率相近（P=0.250 -0.757）.结论 老年局限期小细胞肺癌同期放化疗的实施要谨慎进行,序贯放化疗可能是一种替代选择.

Objective We aimed to investigate whether the standard approach of concurrent chemotherapy and radiation is an appropriate choice for elderly patients with limited-stage small-cell lung cancer （LS-SCLC）.Methods A total of 168 LS-SCLC patients who had received thoracic radiotherapy from January 2006 to December 2011 at our institution were included in this retrospective study.Patients aged 65 years or older were defined as elder,and we compare concurrent chemoradiotherapy （CCRT） to sequential chemoradiotherapy （SCRT） in the elderly group （53 patients） and in its younger （153 patients） counterpart.Results The follow-up rate was 95.2% （each of the two groups lost in 4 patients）.The median OS and PFS for the entire cohort was 24.6 months and 15.4 months.Among the elderly patients,the median OS were 15.9 and 24.6 months （P =0.013） in the CCRT and SCRT subgroups,respectively,and the toxicity were similar except for that more grade 3/4 hematological toxicity events were observed in the CCRT subgroup （13.3% versus 2.6%,P =0.170）.Among the young patients,the median OS was 39.6 months in the CCRT subgroup and 24.5 months in the SCRT group （P =0.018）,and no significant differences occurred in toxicity between the two subgroups （P=0.250-0.757）.Conclusions Concurrent chemoradiotherapy should be used with caution in elderly patients,and sequential chemotherapy may be an alternative choice.