胸部序贯放疗较巩固放疗延长广泛期小细胞肺癌无进展生存期

Sequential Thoracic Radiotherapy Improves Progression Free Survival of Patients with Extensive-disease Small Cell Lung Cancer,Compared with Consolidative Thoracic Radiotherapy

目的比较胸部序贯放疗与巩固放疗在广泛期小细胞肺癌(ED-SCLC)的意义。方法收集2010年1月至2013年6月期间接受胸部放疗的ED-SCLC患者102例。运用Kaplan-Meier法对序贯胸部放疗和巩固放疗的2组患者的无进展生存(PFS)及总生存(OS)进行生存分析。结果序贯放疗组中位PFS、1年PFS率依次为11.0月、39.6%,巩固放疗组依次为9.4月、7.7%(P=0.000)。序贯放疗组中位、1年、2年OS率依次为15.0月、77.7%、4.6%;巩固放疗组依次为14.2月、82.4%、2.4%(P=0.58)。单因素分析发现PS评分=0分,化疗>3程及序贯放疗改善PFS。多因素分析发现化疗>3程及序贯放疗是影响PFS的两个独立预后因子。亚组分析发现无论化疗≤3程还是>3程,序贯放疗组PFS皆延长。结论胸部序贯放疗可延长部分高选择性ED-SCLC患者的PFS。化疗疗程>3程和序贯放疗是其两个独立预后因素。

Objective To explore the effect of sequential thoracic radiotherapy on extensive-disease small cell lung cancer（ED-SCLC） compared with consolidative radiotherapy.Methods We collected 102 patients with ED-SCLC who received thoracic radiotherapy from January 2010 to June 2013.The progression free survival（PFS） and overall survival（OS） of two radiotherapy arms（sequential vs.consolidative radiotherapy） were analyzed by Kaplan-Meier curve method.Results The median PFS and 1-year PFS rates were 11.0 month,and 39.6% in sequential thoracic radiotherapy group,9.4 month and 4.6% in consolidative radiotherapy group（P=0.000）.The median OS,1-year and 2-year OS rates were 15.0m,77.7% and 4.6% in sequential group,14.2m,82.4% and 2.4% in consolidative group（P=0.58）.Univariate analysis showed that performance status（PS） score（=0）,cycles of chemotherapy（〉3） and sequential thoracic radiotherapy were significantly associated with better PFS（P=0.005） and multivariate analysis indicated that cycles of chemotherapy（〉3） and sequential radiotherapy were independent favorable prognostic factors.Further,subgroup analysis showed that whether chemotherapy cycles 〉3 or ≤3,the PFS of patients who received sequential thoracic radiotherapy was longer.Conclusion Sequential thoracic radiotherapy could improved the PFS of some highly selective patients with ED-SCLC.Cycles of chemotherapy（〉3） and sequential thoracic radiotherapy are two independent prognostic factors.