不同放化疗组合方案对广泛期SCLC预后影响  

Effects of different chemoradiotherapy schemes on the prognosis of extensive-stage small-cell lung cancer

作　　者：罗婧[1] 徐利明[1] 赵路军[1] 王煜雯 庞青松[1] 王军[1] 袁智勇[1] 王平[1] Luo Jing Xu Liming Zhao Lujun Wang Yuwen Pang Qingsong Wang Jun Yuan Zhiyong Wang Ping(Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin 300060, Chin)

机构地区：[1]天津医科大学肿瘤医院放疗科家肿瘤临床研究中心天津市“肿瘤防治”重点实验室、津市恶性肿瘤临床医学研究中心,300060

出　　处：《中华放射肿瘤学杂志》2016年第11期1166-1171,共6页Chinese Journal of Radiation Oncology

摘　　要：目的：探讨不同放化疗组合方案对广泛期SCLC预后的影响。方法回顾分析2011—2015年收治的322例广泛期SCLC患者，均接受依托泊苷＋顺铂或卡铂标准方案化疗；根据RECIST标准将化疗后疗效分为CR、PR、SD、PD，排除化疗后进展的90例，共入组232例。根据化疗有效后是否行放疗将患者分为放疗组（187例）和无放疗组（45例）。根据放疗的早晚分为早放疗组（化疗≤3个周期接受放疗，65例）和晚放疗组（化疗＞3个周期接受放疗，122例）。根据放疗和化疗顺序分为同步放化疗组（45例）和序贯放化疗组（142例）。 Kaplan.Meier计算生存率，Logrank检验差异，Cox模型多因素预后分析。结果中位 OS、PFS、LRFS 全组分别为13.2、8.7、14.6个月；无放疗组分别为8.7、5.6、5.9个月，有放疗组分别为15.0、9.8、19.2个月（ P＝0.00、0.00、0.00）；早放疗组分别15.4、8.0、19.2个月，晚放疗组分别为14.6、10.8、18.1个月（ P＝0.720、0.426、0.981）；同步放化疗组分别为19.4、10.8、19.8个月，序贯放化疗组分别为13.8、9.8、17.8个月（ P＝0.036、0.656、0.768）。接受放疗患者不良反应较无放疗患者增加（ P＝0.038），但≥3级严重不良反应相似（ P＝0.126）。结论广泛期SCLC化疗有效者行胸部放疗可提高疗效，严重不良反应未见明显增加。放疗的早晚与预后关系不大。同步放化疗有可能进一步提高疗效，但仍需更深入研究。Objective To investigate the effects of different chemoradiotherapy （ CRT） schemes on the prognosis of extensive.stage small.cell lung cancer （ SCLC ） . Methods A retrospective analysis was performed in 322 patients with extensive.stage SCLC who were admitted to our hospital from 2011 to 2015.All patients received standard EP/CE （ etoposide＋cisplatin/carboplatin） chemotherapy. According to RECIST criteria, the efficacy of chemotherapy was divided into complete response, partial response, stable disease, and progressive disease （ PD）. A total of 232 patients without PD after chemotherapy were enrolled as subjects and divided into radiotherapy group （n=187） and non.radiotherapy group （n=45）.The patients undergoing radiotherapy were further divided into early radiotherapy group （ before 3 cycles of chemotherapy, n=65） and late radiotherapy group （after 3 cycles of chemotherapy, n=122）,or concurrent CRT group （ n=45 ） and sequential CRT group （ n=142 ） . The survival rates were analyzed using the Kaplan.Meier method. Between.group comparison was made by log.rank test. The Cox regression model was used for multivariate prognostic analysis. Results In all the patients, the median overall survival （ OS ） , progression.free survival （PFS）,and local recurrence.free survival （LRFS） time was 13.2,8.7,and 14.6 months, respectively. The non.radiotherapy group had significantly shorter median OS, PFS, and LRFS time than the radiotherapy group （ 8.7 vs. 15.0 months, P=0.00;5.6 vs. 9.8 months, P=0.00;5.9 vs. 19.2 months, P=0.00）.There were no significant differences in median OS, PFS, or LRFS time between the early radiotherapy group and the late radiotherapy group （ 15.4 vs. 14.6 months, P=0.720;8.0 vs. 10.8 months, P=0.426;19.2 vs. 18.1 months, P=0.981） . The concurrent CRT group had significantly longermedian OS time than the sequential CRT group （19.4 vs. 13.8 months, P=0.036）,while there were no significant differences in median PFS or LRFS time between the t

关 键 词：癌 小细胞肺/放射疗法 癌 小细胞肺/化学疗法 放化疗法 同步 放化疗法 序贯 预后 

分 类 号：R734.2[医药卫生—肿瘤]