局限期小细胞肺癌不同定位方式放疗联合化疗的疗效和预后分析

Long-term result and prognostic analysis of concurrent chemotherapy and radiotherapy in different ways for limited small cell lung cancer

目的：比较局限期小细胞肺癌普通X线模拟定位、CT定位以及PET/CT定位三维适形放疗（3DCRT）协同化疗的疗效、不良反应和预后。方法：回顾性分析12年间局限期小细胞肺癌患者共148例,分别接受普通X线模拟定位（普放组）、CT定位（适形组）和PET/CT定位（PET/CT组）放疗。所有病例均用EP方案（顺铂40mg,d1～3;VP16 100mg/m^2,d1～5）化疗4～6周期;随访并比较各种治疗方法的疗效、不良反应和预后。结果：PET/CT组的平均GTV与PTV体积均比适形组小,PET/CT组的左肺与右肺V20、心脏、食管与脊髓V40均比适形组小（P均〈0.05）;近期总有效率差异无统计学意义（P〉0.05）。普放组的早期与晚期放射反应均高于适形组与PET/CT组;PET/CT组中I、II级肺和气管的早期与晚期放射损伤发生率低于适形组（P均〈0.05）。PET/CT组的1、2、3年局部控制率与生存率均高于适形组（P均〈0.01）。PET/CT组纵隔淋巴结复发率低于适形组,放化疗后手术切除残存病灶者预后好;治疗失败的主要原因为远处转移。结论：PET/CT定位可以优化局限期小细胞肺癌的放疗设野计划,减少正常组织的照射体积与纵隔复发率。放化疗后手术切除残存病灶预后好,远处转移为主要失败原因。

Objective： To analyse the result and prognosis of concurrent chemotherapy and radiotherapy by ordinary X-based simulation,CT simulation,PET / CT positioning three-dimensional conformal radiotherapy（ 3DCRT） for limited small cell lung cancer. Methods： To review 148 patients with limited small cell lung cancer by ordinary X ray simulator（ normal group）,CT localization（ CRT group） and PET / CT localization（ PET / CT group） radiotherapy. All cases were treated by EP program（ VP16 100 mg / m^2,d1 ～ 5; Cisplatin 40 mg,d1 ～ 3） chemotherapy for 4 ～ 6 cycles. Results： The average volume of GTV and PTV of the PET / CT group was smaller than that of the CRT group,the left lung and right lung V20,heart,sophagus and spinal cord V40 of the experimental group was smaller than that of the control group（ all P〈0. 05）. The short-term total effective rate of the three groups was not statistically significant（ P〉0. 05）. The early and late radiation reactions of the normal group were higher than that of the CRT group and the PET / CT group. The I,II-grade early and late radiation injury rate of the lung and trachea of the PET / CT group was lower than that of the CRT group（ all P〈0. 05）. The 1,2,3-year local control rates and survival rate of the PET /CT group were higher than that of the CRT group（ all P〈0. 01）. The mediastinal lymph node recurrence rate of the PET / CT group was lower than that of the CRT group. The prognosis of post-chemotherapy residual tumor resection was good. The main reason for treatment failure was distant metastasis. Conclusion： Using PET / CT to determine the target of limited small cell lung cancer can improve the radiation treatment plan,reduce the recurrence rate of mediastinal,the prognosis of post-chemotherapy residual tumor resection is good. Distant metastasis was the main reason for failure.