化放疗综合治疗95例局限期小细胞肺癌的疗效分析  

Chemotherapy combined with chest radiation therapy in the treatment of 95 patients with limited stage small cell lung cancer

作　　者：陈桂园[1] 王丽娟[1] 蒋国樑[1] 钱浩 傅小龙[1] 赵森[1] 丁琳 

机构地区：[1]复旦大学医学院(原上海医科大学)附属肿瘤医院放疗科,上海 200032

出　　处：《中国肺癌杂志》2000年第5期340-343,共4页Chinese Journal of Lung Cancer

摘　　要：目的　回顾性分析 95例局限期小细胞肺癌 (limitedstagesmallcelllungcancer,LSCLC)化放疗综合治疗的疗效和影响预后的因素。方法　经病理证实的局限期小细胞肺癌 95例 ,男 84例 ,女 11例。中位年龄5 8岁 (32～ 75岁 )。按 1997年UICC的TNM分期法 ,Ⅰ期 3 % (3/95 ) ,Ⅱ期 7% (7/95 ) ,ⅢA期 5 2 % (49/95 ) ,ⅢB期 38% (36 /95 )。放疗 :照射野包括原发灶 +同侧肺门 +上纵隔 (原发灶位于上、中叶 ) /全纵隔 (原发灶位于下叶 ) ,不作锁骨上区及脑的预防性照射。肿瘤中位剂量 :5 9.1Gy(43 .8～ 76 .9Gy) /31次 (2 2～ 6 4次 ) /4 8天 (30～73天 )。放疗于化疗 1疗程后开始。化疗方案 :CAP(环磷酰胺、阿霉素、顺铂 )以及EP(依托泊甙、顺铂 )、TP(替尼泊甙、顺铂 )或IEP(异环磷酰胺、依托泊甙、顺铂 )。中位化疗疗程为 6个 (1～ 10个 )。结果　治疗结束后 2月评价近期疗效 ,完全缓解 (CR) 5 8% (5 5 /95 ) ,部分缓解 (PR) 38% (36 /95 ) ,缓解率达 96 % (91/95 )。中位生存时间为 2 8个月。 1、2、3、5年生存率分别为 85 %、6 2 %、31%、13 %。 1、2、3、5年局部控制率分别为 95 %、86 %、77%、6 4%。 1、2、3、5年远处转移率分别为 2 3%、5 2 %、73 %、83 %。Cox回归模型分析显示治疗前一般状态评分Objective To analyse retrospectively the results and prognostic factors of 95 patients with limited stage small cell lung cancer treated with chemotherapy plus chest radiation therapy. Methods Ninetyfive patients with limited stage small cell lung cancer were treated with combination chemotherapy plus chest radiation therapy from December, 1989 to June, 1997. There were 84 males and 11 females with median age of 58 years (32～75 years). The PTNM stages of the disease were as follows: stage Ⅰ disease, 3 patients; stage Ⅱ disease, 7 patients; stage ⅢA disease, 49 patients and stage ⅢB disease, 36 patients. Chemotherapy regimens were CAP (cyclophosphamide, doxorubicin, cisplatin), EP(etoposide, cisplatin), TP(Teniposide, cisplatin), or IEP (ifosphamide, etoposide, cisplatin). Median cycles were 6 (1～10). After one cycle of chemotherapy, patients received chest radiation therapy with median total tumor dose of 59.1?Gy(43.8～76.9?Gy)/31fx(22～64?fx) for 48 days(30～73?days). The radiation fields covered tumors with 1.5～2.0?cm margins. Supraclavicular region and brain did not receive prophylactic irradiation. Results Of the ninetyfive patients, 55(58%) had a complete response, 36(38%) had a partial response, three had a stable disease and one had a disease progression. The median survival time was 28 months. The 1, 2, 3 and 5year survival rates were 85%, 62%, 31% and 13%, respectively. The 1, 2, 3, and 5year local control rates were 95%, 86%, 77% and 64%, respectively. The 1, 2, 3 and 5year distant metastasis rates were 23%, 52%, 73%, and 83%, respectively. From multivariate regression analyses, KPS≥70 and complete response and partial response could be the favorable predictors. Conclusion Chemotherapy combined with chest irradiation in limited stage small cell lung cancer can get better survival and local control and less distant metastases. KPS≥70 and complete response and partial response might be the favorable predictors.

关 键 词：局限期小细胞肺癌 化学治疗 放射治疗 综合治疗 

分 类 号：R734.205[医药卫生—肿瘤] R730.58[医药卫生—临床医学]