同期放化疗治疗局限期小细胞肺癌患者放疗分割模式比较分析

Comparison of hyperfractionation and conventional fractionation with concurrent chemoradiotherapy for limited-stage small cell lung cancer

目的观察同期放化疗治疗局限期小细胞肺癌放疗分割模式选择的临床效果。方法将96例局限期小细胞肺癌患者,随机分成两组,化疗联合同期超分割组(1.5Gy/次,2次/d,总剂量45Gy)46例,化疗联合同期常规分割组(2Gy/次,1次/d,总剂量60~66Gy)50例。化疗方案为依托泊苷联合顺铂(EP)方案,1~2周期后介入放疗,放疗采用累及野的三维适形调强放疗,两组治疗后达完全缓解(CR)或近CR者序贯行脑预防性照射。比较两组患者的近期临床疗效、不良反应和近期生存率。结果化疗联合同期超分割组和化疗联合同期常规分割组的局部控制率分别为82.61%和78%,1、2、3年的生存率分别为84.78%、60.87%、36.96%和72.00%、54.00%、34.00%,差异无统计学意义(P>0.05);而放射性食道炎分别为32.61%和32.00%,差异无统计学意义(P>0.05);放射性肺炎为17.39%和36.00%,差异有统计学意义(P<0.05);骨髓抑制主要表现在粒细胞减少,胃肠反应主要表现在恶心、呕吐,两组发生率均比较高,差异无统计学意义(P>0.05)。结论化疗联合同期超分割放疗与常规分割放疗治疗局限期小细胞肺癌临床疗效相当,不良反应患者能耐受,在临床上均可行。

Objective To observe the clinical effect of simultaneous radiotherapy and chemotherapy in the treatment of limited-stage small cell lung cancer.Methods Nighty-six patients with localized small cell lung cancer were randomly divided into two groups:chemotherapy combined with hyperfractionation group(1.5 Gy/twice a day,total dose 45 Gy)46 cases,and chemotherapy combined with conventional fractionation group(2 Gy/once a day,total dose 60-66 Gy)50 cases.The chemotherapy regimen was EP regimen.After 1-2 cycles,interventional radiotherapy was used,and the radiotherapy was treated with three-dimensional conformal intensity modulated radiotherapy involving the field.The patients in the two groups who reached CR or near CR after treatment were treated with prophylactic brain irradiation.The short-term clinical efficacy,adverse reactions and short-term survival rate were compared between the two groups.Results The local control rates of chemotherapy combined with hyperfractionation group and chemotherapy combined with conventional fractionation group were 82.61%and78%,respectively.The 1,2 and 3 year survival rates were 84.78%,60.87%,and 36.96%,respectively,and 72.00%,54.00%and 34.00%,respectively.The difference was not statistically significant(P>0.05).The incidence of radiation esophagitis was 32.61%and 32.00%respectively,and the difference was not statistically significant(P>0.05).Radiation pneumonia was 17.39%and 36.00%,respectively.The difference was statistically significant(P<0.05).The main manifestation of myelosuppression is neutropenia.Gastrointestinal reactions were mainly now nausea and vomiting,the incidence of the two groups was relatively high,the difference was not statistically significant(P>0.05).Conclusion The clinical efficacy of chemotherapy combined with hyperfractionated radiotherapy and conventional fractionated radiotherapy is similar to that of conventional fractionated radiotherapy in the treatment of limited-stage small cell lung cancer.The adverse reaction can be tolerated by the patients.Both methods are clinically feasible.