胸部3DCRT在广泛期SCLC中的应用研究  

Role of thoracic conformal radiotherapy in patients with extensive-stage small cell lung cancer

作　　者：栾祖鹏[1] 王志武[2] 黄伟[2] 张健[2] 董玮[2] 张炜[2] 李宝生[2] 

机构地区：[1]国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津医科大学肿瘤医院放疗科,天津300060 [2]山东省肿瘤医院放疗科,济南250117

出　　处：《中华放射肿瘤学杂志》2014年第5期402-405,共4页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金项目（81272501）

摘　　要：目的 评价胸部3DCRT在广泛期SCLC中的价值.方法 选择2004-2009年间收治的171例广泛期SCLC患者纳入研究,其中86例接受胸部3DCRT和全身化疗,85例只接受全身化疗.放疗采用超分割（1.5 Gy/次,2次/d）或常规分割（2.0Gy/次,1次/d）方式,总量40 ～62Gy.化疗方案为铂类联合依托泊甙.生存计算采用Kaplan-Meier法并Logrank检验和单因素预后分析,Cox模型多因素预后分析.结果 随访率为100％.全组中位OS期、2年OS率、5年OS率全组分别为15个月、31.5％、2.4％,放疗组的分别为18个月、35.3％、2.4％,化疗组的分别为12个月、14.5％、2.4％（P =0.023）.全组中位PFS期、1年PFS率、2年PFS率全组分别为8个月、27.5％、2.4％,放疗组的分别为9个月、35.4％、6.0％,化疗组的分别为6个月、20.5％、6.0％（P=0.004）.放疗组中超分割总量45 Gy的22例患者中位PFS期11个月,常规分割总量60Gy的26例患者中位PFS期9个月（P=0.037）.多因素分析显示3DCRT、4周期以上化疗是预后有利因素（P=0.008、0.001）.结论 胸部放疗能改善广泛期SCLC患者OS和PFS,总量45Gy超分割放疗较佳.胸部放疗和4周期以上化疗对OS是独立的预后有利因素.Objective To evaluate the role of thoracic three-dimensional conformal radiotherapy （3DCRT） in patients with extensive-stage small cell lung cancer （ES-SCLC）.Methods A total of 171 patients with ES-SCLC admitted from 2004 to 2009 were included in the study.Eighty-six patients received thoracic 3DCRT and systemic chemotherapy （CT）,while 85 patients received systemic CT alone.3DCRT was delivered at 1.5 Gy/fraction twice daily or 2.0 Gy/fraction once daily,with a total dose ranging from 40 to 62 Gy.The CT regimen consisted of carboplatin/cisplatin and etoposide.The survival time and survival rate were calculated by the Kaplan-Meier method,and the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100%.The median overall survival （OS） time and the 2-and 5-year OS rates were 15 months,31.5%,and 2.4%,respectively,for all patients;they were 18 months,35.3%,and 2.4%,respectively,for the CT/3DCRT group,versus 12 months,14.5%,and 2.4% for the CT group （P =0.023）.The median progression-free survival （PFS） time and the 1-and 2-year PFS rates were 8 months,27.5%,and 2.4%,respectively,for all patients;they were 9 months,35.4%,and 6.0%,respectively,for the CT/3DCRT group,versus 6 months,20.5%,and 6.0% for the CT group （P =0.004）.In the CT/3DCRT group,the 22 patients who received 45 Gy at 1.5 Gy/fraction twice daily had a median PFS time of 11 months,versus 9 months for the 26 patients who received 60 Gy at 2.0 Gy/fraction once daily （P =0.037）.Multivariate analysis revealed that receiving ≥ 4 cycles of CT （P =0.001） and 3DCRT （P =0.008） were favorable prognostic factors for OS.Conclusions Thoracic 3DCRT can improve the OS and PFS in patients with EDSCLC,and it has good efficacy when delivered with a total dose of 45 Gy at 1.5 Gy/fraction twice daily.Thoracic 3DCRT and receiving ≥4 cycles of CT are independent favorable prognostic factors for OS.

关 键 词：肺肿瘤/放射疗法 放射疗法 三维适形 放射疗法 超分割 预后 

分 类 号：R734.2[医药卫生—肿瘤]