IMRT下局限期SCLC放化疗疗效及预后分析

Clinical efficacy and prognostic factors of intensity-modulated radiotherapy combined with chemotherapy for limited-stage small cell lung cancer

目的 探讨IMRT技术下局限期SCLC放化疗疗效及预后分析。方法 回顾分析2006—2014年于本中心行放化疗的 484例局限期SCLC患者临床资料。IMRT有效者行PCI。采用Kaplan-Meier法计算生存率,Logrank检验进行单因素分析,Cox模型进行多因素分析。结果 全组随访率为93%,中位OS期23.8个月,2、3、5年OS率分别为48.7%、39.8%、28.6%,中位PFS期14.1个月,2、3、5年PFS率分别为34.4%、30.5%、28.3%。SCLC患者IMRT后≥3级骨髓抑制发生率26.9%,≥2级放射性食管炎发生率24.8%,≥2级放射性肺炎发生率18.4%。治疗客观有效率84.5%。单因素分析显示年龄、吸烟史、TNM分期、PCI、放疗前化疗周期数是预后影响因素（P=0.006、0.001、0.047、0.000、0.046）,多因素分析显示吸烟史、PCI是影响预后的因素（P=0.001、0.000）。结论 IMRT技术下局限期SCLC放化疗取得了较好疗效,吸烟史、PCI是局限期SCLC的预后影响因素。

Objective To investigate the clinical efficacy and prognosis of intensity-modulated radiotherapy （IMRT） combined with chemotherapy for limited-stage small cell lung cancer （LS-SCLC）. Methods A retrospective analysis was performed on the clinical data of 484 LS-SCLC patients treated with chemoradiotherapy in our center from 2006 to 2014. The patients with partial or complete response to IMRT received prophylactic cranial irradiation （PCI）. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test and Cox regression were used for univariate and multivariate analyses, respectively. Results In all the patients, the follow-up rate was 93%;the median overall survival （OS） time was 23.8 months;the 2-, 3-, and 5-year OS rates were 48.7%, 39.8%, and 28.6%, respectively;the median progression-free survival （PFS） time was 14.1 months;the 2-, 3-, and 5-year PFS rates were 34.4%, 30.5%, and 28.3%, respectively. The incidence rates of grade ≥3 bone marrow suppression, grade ≥2 radiation esophagitis, and grade ≥2 radiation pneumonitis were 26.9%, 24.8%, and 18.4%, respectively, in SCLC patients after IMRT. The objective response rate was 84.5%. The univariate analysis showed that age, smoking history, TNM stage, PCI, and the number of chemotherapy cycles before radiotherapy were prognostic factors for OS （P=0.006, 0.001, 0.047, 0.000, and 0.046）. The multivariate analysis showed that smoking history and PCI were independent prognostic factors （P=0.001 and 0.000）. Conclusions IMRT combined with chemotherapy achieves satisfactory clinical outcomes in the treatment of LS-SCLC. Smoking history and PCI are independent prognostic factors for OS of LS-SCLC patients.