局限期SCLC超分割或大分割放疗同步化疗预后比较  

Effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined withconcurrent chemotherapy on prognosis of limited-stage small-cell lung cancer

作　　者：胡晓[1] 夏冰 包勇[4] 徐裕金[1] 王谨[1] 马红莲[1] 金莹[2] 方敏[1] 唐华容[1] 陈梦圆[1] 董百强[1] 傅小龙 陈明[1] 

机构地区：[1]浙江省肿瘤医院放疗科浙江省放射肿瘤学重点实验室,杭州310022 [2]浙江省肿瘤医院放疗科化疗科,杭州310022 [3]杭州市肿瘤医院放疗科,复旦大学附属肿瘤医院放疗科 [4]中山大学肿瘤防治中心放疗科,广州510060 [5]上海交通大学附属胸科医院放疗科,复旦大学附属肿瘤医院放疗科,200030

出　　处：《中华放射肿瘤学杂志》2017年第9期1000-1005,共6页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金（81402540、81401911、81672972）;国家卫生计生委科学研究基金-浙江省医药卫生重大科技计划（省部共建计划）项目（wKJ-ZJ-1701）

摘　　要：目的 比较超分割或大分割放疗同步化疗对局限期SCLC的生存影响。方法 超分割和大分割组分别入组患者92、96例。超分割组采用45 Gy分30次,2 次/d。大分割组采用55 Gy分22次,1 次/d。采用Kaplan-Meier法计算生存率,Cox模型多因素预后分析。结果 超分割和大分割组患者1、2、5年PFS率分别为82%、61%、59%和85%、69%、69%（P=0.27）,OS率分别为85%、41%、27%和77%、34%、27%（P=0.37）。多因素分析显示化疗开始到放疗开始时间≤43 d是PFS的有利因素（P=0.005）,化疗开始到放疗结束时间≤63 d、PCI是OS有利因素（P=0.044、0.000）。超分割组和大分割组2、3级急性放射性食管炎发生率分别为28%、9%和16%、2%（P=0.009）。结论 采用加速超分割或大分割方案联合同步化疗的PFS及OS均显著提高。控制化疗开始至放疗开始、结束时间≤43 d、≤63 d有利于提高PFS和OS。但2、3级急性放射性食管炎的发生率超分割组显著高于大分割组。Objective To investigate the effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on the prognosis of limited-stage small-cell lung cancer （SCLC）. Methods A total of 188 patients with limited-stage SCLC were enrolled in this study and divided into hyperfractionated group （n=92） and hypofractionated group （n=96）. The hyperfractionated group received thoracic radiotherapy at 45 Gy in 30 fractions twice a day, while the hypofractionated group received 55 Gy in 22 fractions once a day. The Kaplan-Meier method was used to calculate survival rates, and the Cox model was used for multivariate prognostic analysis. Results There were not significant differences in 1-, 2-, and 5-year progression-free survival （PFS） rates and 1-, 2-, and 5-year overall survival （OS） rates between the hyperfractionated group and the hypofractionated group （82% vs. 85%, 61% vs. 69%, 59% vs. 69%, P=0.27;85% vs. 77%, 41% vs. 34%, 27% vs. 27%, P=0.37）. The multivariate analysis showed that the time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days was favorable prognostic factor for PFS （P=0.005）. The time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days and prophylactic cranial irradiation were favorable prognostic factors for OS （P=0.044;P=0.000）. There were significant differences in incidence rates of grade 2 and 3 acute radiation esophagitis between the two groups （28% vs. 16%, 9% vs. 2%, P=0.009）. Conclusions Both hyperfractionated radiotherapy and hypofractionated radiotherapy combined with chemotherapy can improve the PFS and OS of patients with limited-stage SCLC. The time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days and the time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days are favorable prognostic factors for PFS and OS, respectively. However, the hyperfractionated group has signific

关 键 词：肺肿瘤/放射疗法 放射疗法  调强 放射疗法  超分割 放射疗法  大分割 肺肿瘤/化学疗法 预后 

分 类 号：R734.2[医药卫生—肿瘤]