局限期小细胞肺癌化疗联合同期三维适形超分割放疗的临床研究

目的探讨局限期小细胞肺癌化疗联合同期三维适形超分割放疗的疗效和生存率。方法将60例局限期小细胞肺癌患者按随机数字表法分为2组：同步放化疗组（n=30）和序贯治疗组（n=30）。2组化疗均采用EP方案（VP-16 75mg.m-2.d-1,d1-d5＋DDP 80mg.m-2.d-1,d1）化疗4～6个周期;放疗采用三维适形放疗（3DCRT）,6MV-X线,超分割照射,1.5Gy.次-1,2次.d-1,总剂量45Gy.30次-1。同步放化疗组从化疗第1天开始实施三维适形超分割放疗。序贯治疗组从化疗4周期后采用三维适形超分割放疗。2组中治疗达完全缓解（CR）的患者行脑预防性照射（PCI）。结果同步放化疗组和序贯治疗组的完全缓解率为46.7%和16.7%（P=0.025）,总有效率分别为83.3%和53.3%（P=0.013）;2组毒副作用比较差异无统计学意义（P〉0.05）;同步放化疗组和序贯治疗组1、2、3年生存率分别为86.7%、63.3%、30.0%和73.3%、30.0%、16.7%,同步放化疗组优于序贯治疗组（P=0.035）;同步放化疗组和序贯治疗组局部复发率分别为16.7%和40.0%（P=0.047）,远处转移率分别为36.7%和66.7%（P=0.038）。结论化疗联合同期三维适形超分割放疗对局限期小细胞肺癌具有较好的疗效,其完全缓解率和总生存率得到明显提高。

Chemotherapy Plus Three-dimensional Conformal Hyperfractionated Radiotherapy for Limited-stage Small-cell Lung Cancer

Objective To evaluate the efficacy of chemotherapy in conjunction with three-dimensional conformal hyperfractionated radiotherapy in the treatment of limited-stage small-cell lung cancer（SCLC）.Methods Sixty patients with limited-stage SCLC were randomly assigned to receive either concurrent chemoradiotherapy（C group,n=30） or sequential chemoradiotherapy（S group,n=30）.All patients were treated with 4-6 cycles of EP scheme（VP-16 75 mg·m-2·d-1,d1-d5＋DDP 80 mg·m-2·d-1,d1）.Radiation was delivered with a three-dimensional conformal hyperfractionated technique using 6MV-X ray（1.5 Gy twice daily,equal to 45 Gy in 15 days continuously）.Three-dimensional conformal hyperfractionated radiotherapy was performed from the first day of chemotherapy and after the fourth chemotherapy cycle in the C group and S group,respectively.Patients achieved complete remission（CR） were given prophylactic cranial irradiation（PCI）.Results The CR rate was 46.7% and 16.7%（P=0.025） and total effective rate was 83.3% and 53.3%（P=0.013） in C group and S group,respectively.There were no significant differences in adverse reactions between the two groups（P0.05）.The 1-3-year survival rates in C group（86.7%,63.3% and 30.0%,respectively） were obviously higher than those in S group（73.3%,30.0% and 16.7%,respectively）（P=0.035）.Local recurrence rate was 16.7% and 40.0%（P=0.047） and distant metastasis rate was 36.7% and 66.7%（P=0.038） in C group and S group,respectively.Conclusion The chemotherapy in conjunction with three-dimensional conformal hyperfractionated radiotherapy can significantly increase CR rate and survival rate in patients with limited-stage SCLC.