局限期小细胞肺癌同步放化疗中不同靶区勾画模式对疗效及毒性反应影响的对比研究

Comparative study on the efficacy and toxicity of different clinical target volume models in limited disease small cell lung cancer with concurrent chemoradiotherapy

目的探讨局限期小细胞肺癌(LD-SCLC)同步放化疗中原发灶大体靶区(GTV_(primary))扩大与不扩大临床靶区(CTV)2种靶区勾画模式对疗效及毒性反应的影响。方法回顾性分析2016年10月至2020年10月中日友好医院放射肿瘤科收治的89例接受同步放化疗的LD-SCLC病例资料,其中,45例接受了GTV_(primary)外扩的治疗方案(A组),44例接受了GTV_(primary)不外扩的治疗方案(B组)。比较分析2组治疗的有效率、毒性反应发生率及远期生存等指标。结果86例患者中位随访时间21.3个月(3.2~60.8个月)。A组与B组患者的近期有效率分别为79.1%和76.7%(P=0.795),总体局部进展率为37.2%,中位无进展生存时间分别为13.2和12.1个月(P=0.648),中位总生存时间分别为21.5和20.3个月(P=0.667),包括一线治疗进展模式在内,2组间均无统计学差异。3度及以上放射性肺炎A组为16.3%,B组为4.5%,A组有增高的趋势(P=0.078)。结论同步放化疗过程中,原发灶肿瘤靶区GTV_(primary)不外扩CTV并不影响患者的近期和远期疗效,且能降低放化疗过程中的3度及以上放射性肺炎的发生概率。

Objective To explore expanded and non-expanded methods for delineating target primary gross tumor volume(GTV_(primary))and to compare their efficacy and side effects on clinical target volume(CTV)during concurrent chemoradiotherapy of limited disease small cell lung cancer(LD-SCLC).Methods Information was collected on 89 patients who received concurrent chemoradiotherapy from October 2016 to October 2020,including 45 cases of GTV_(primary)that were expanded to CTV(group A)and 44 cases of GTV_(primary)that were not expanded to CTV(group B).Statistical analysis was conducted to compare parameters such as side effects,efficacy rates,and survival rates.Results The median follow-up time was 21.3 months(range,3.2 to 60.8 months).The short-term effective rates for the group A and group B were 79.1%and 76.7%,respectively(P=0.795);the median progression-free survival time were 13.2 and 12.1 months,respectively(P=0.648);the median overall survival time were 21.5 and 20.3 months,respectively(P=0.667);and the local progression rate of both groups was 37.2%.No significant difference was found between the two groups,even in the first-line treatment progress mode;however,16.3%of cases in the group A and 4.5%of cases in the group B(P=0.078)acquired radiation pneumonia of grade 3 or above.Conclusion The target GTV_(primary)does not expand CTV during concurrent chemoradiotherapy,nor does it affect the short-and long-term efficacy rates of patients;in addition,it can reduce the incidence of radiation pneumonia of grade 3 or above.