不同介入时机预防性全脑照射对局限期小细胞肺癌疗效的影响

Curative effect of prophylactic cranial irradiation at different timing of intervention on limited-stage small cell lung cancer

目的分析不同介入时机预防性全脑照射(PCI)对局限期小细胞肺癌(LSCLC)交替放化疗完全缓解(CR)后脑转移率和生存率的影响。方法对该院90例LSCLC患者进行回顾性分析,将其分为短周期组(51例),长周期组(39例)。两组均进行胸部放疗、化疗(依托泊苷+顺铂)2个周期。短周期组化疗2个周期后给予PCI治疗;而长周期组化疗4个周期后给予PCI治疗,并比较两组脑转移率和生存率。结果短周期组3年内脑转移率为12/51(23.53%),长周期组为20.51%(8/39);两组3年内脑转移率比较,差异无统计学意义(P>0.05)。短周期组第1、2及3年总生存率分别为82.35%、39.22%及21.57%,中位生存时间为15个月;长周期组第1、2及3年总生存率分别为76.92%、43.59%和23.08%,中位生存时间为18个月。两组第1、2及3年总生存率比较,差异无统计学意义(P>0.05)。短周期组第1、2及3年局部无进展生存率分别为54.90%、19.61%和15.69%,长周期组分别为66.67%、23.08%和12.82%,且两组中位局部无进展生存期均为16个月。两组第1、2及3年局部无进展生存比较,差异无统计学意义(P>0.05)。两组不良反应发生率、肿瘤复发及转移发生率比较,差异无统计学意义(P>0.05)。结论采取不同介入时机PCI对LSCLC交替放化疗CR后脑转移率和生存率较为接近,无较大差异。

Objective To analyze the effects of prophylactic cranial irradiation on brain metastasis rate and survival rate in patients with limited-stage small cell lung cancer on alternate chemoradiotherapy after complete remission（CR） at different interventional time. Methods A retrospective analysis of 90 patients with limited-stage small cell lung cancer in our hospital, they were divided into the short-period group（51 cases） and long-period group（39 cases）. 90 cases were given radiotherapy, Etoposide ＋ Cisplatin chemotherapy for 2 cycles; the prophylactic cranial irradiation was given after 2 cycles of Etoposide ＋ Cisplatin chemotherapy in the short-period group, while the prophylactic cranial irradiation therapy was given after 4 cycles of Etoposide ＋ Cisplatin chemotherapy in the long-period group. The brain metastasis rate and survival rate were compared between the two groups. Results The brain metastasis rate in short-period group within 3 years was 23.53%（12/51） and 20.51%（8/39） in the long-period group; the brain metastasis rate in 3 years showed no significantly difference between the two groups（P〉0.05）. The overall survival rates after 1, 2, 3 years in the short-period group were 82.35%, 39.22% and 21.57% and the median survival time was 15 months; the overall survival rates of 1, 2, 3 years in the long-period group were 76.92%, 43.59% and 23.08% and the median survival time was 18 months. The overall survival rates after 1, 2, 3 years showed no significant difference between the two groups（P〉0.05）. The local progression free survival rates after 1, 2, 3 years in the short-period group were 54.90%, 19.61% and 15.69%, and 66.67%, 23.08% and 12.82% in the long-period group. The median progression free survival time of the two groups was 16 months. The local progression free survival after 1, 2, 3 years showed no significant difference between the two groups（P〉0.05）. The incidence rate of adverse reactions, tumor recurrence and metastasis showed no significant difference between the two groups（P〉0.05）. ConclusionThe different intervention times of prophylactic cranial irradiation of alternate chemoradiotherapy after CR in patients with limited-stage small cell lung cancer are close to the brain metastasis rate and survival rate, which isn＇t significant difference.