小细胞肺癌放射治疗进展

Advance in radiotherapy for small cell lung cancer

目的放射治疗是小细胞肺癌治疗的主要方式,其实施过程涉及到小细胞肺癌的诸多环节,总结国内外关于小细胞肺癌放射治疗的研究现状,探讨胸部放射治疗和全脑预防性照射在小细胞肺癌治疗中的价值。方法应用PubMed、西文生物医学期刊文献数据库、中国知网及万方期刊全文数据库检索系统,以"小细胞肺癌,放疗,全脑预防性照射"为中文关键词,以"small cell lung cancer,radiotherapy,prophylactic cranial irradiation"为英文关键词,联合检索1996-01-2016-12的相关文献。共检索到英文文献377篇,中文文献4篇。纳入标准:(1)小细胞肺癌;(2)放疗;(3)全脑预防性照射。排除标准:(1)非小细胞肺癌;(2)手术;(3)化疗。根据剔除标准剔除中文文献2条,英文文献326条,最后纳入分析37篇文献。结果局限期小细胞肺癌的胸部放疗的分割剂量和模式为45Gy/30次,超分割放疗或60~70Gy/30~35次,常规分割放疗。胸部放疗参与的最佳时间为于化疗第1个周期或第2个周期参与。胸部同步放化疗结束以后行全脑预防性照射,放疗期间可给予药物盐酸美金刚以保护神经认知功能或海马保护的调强放射治疗;广泛期小细胞肺癌的胸部放疗的分割剂量和模式为30Gy/10次或45Gy/15次。全脑预防性照射存在争议。结论胸部放射治疗和全脑预防性照射在小细胞肺癌治疗中起着非常重要的作用。

OBJECTIVE Treatment for small cell lung cancer （SCLC） involves many sections,of which radiotherapy is very crucial component. The study aimed to summarize the current status of radiotherapy（RT） and explore the value of thoracic RT and prophylactic cranial irradiation （PCI） for SCLC. METHODS The papers of literature were located through electronic searches of the PubMed, Foreign Medical Journal database,CNKI and Wan fang database（from January 1996 to October 2016） with the keywords ＂SCLC,prophylactic cranial irradiation, radiotherapy＂. A total of 377 English articles and 4 Chinese articles were found. With the inclusion criteria： （1）SCLC; （2）Prophylactic cranial irradiation; （3） Radiotherapy and exclusion criteria ： （1） non-small cell lung cancer（NSCLC） ; （2） chemotherapy; （3） surgery. Finally, thirty-seven papers were chosen. RESULTS Fractionated dose and mode of thoracic RT for localized SCLC is 45/ 1.5 Gy,BID,in 30 fractions,or 60-70 Gy,QD,in 30-5 fractions. The best time to participate in the thoracic RT is in the first or second cycles of chemotherapy. PCI is performanced after concurrent chemotherapy and thoracic RT,Meman- tine and IMRT can be given to protect neurocognitive function or hippocampi during RT. Fractionated dose and mode of thoracic RT for patients with extensive stage SCLC is 30 Gy,QD,in 10 fractions,or 45 Gy,QD,in 15 fractions. But lots of controversies exist in the PC1. CONCLUSION Radiotherapy is the main treatment for SCLC,in which thoracic RT andPCI play a very important role.