1 260例肺小细胞未分化癌综合治疗结果分析  

Results of combined therapy for 1 260 patients with small cell lung cancer

作　　者：陈东福[1] 张湘茹[2] 殷蔚伯[1] 孙燕[2] 苗延浚[1] 冯奉仪[2] 王金万[2] 汪楣[1] 张宏兴[1] 冯勤富[1] 徐兵河[2] 石远凯[2] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放射治疗科,北京100021 [2]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院内科,北京100021

出　　处：《中华肿瘤杂志》2002年第6期602-604,共3页Chinese Journal of Oncology

摘　　要：目的　探讨肺小细胞未分化癌 (SCLC)综合治疗的疗效及影响预后的因素。方法　对12 6 0例SCLC患者 (局限期 732例 ,广泛期 5 0 0例 ,无分期 2 8例 )进行分组治疗 ,其中化疗 +放疗组 5 5 3例 ,化疗 +放疗 +化疗组 35 5例 ,放疗 +化疗组 97例 ,单纯化疗组 12 6例 ,单纯放疗组 6 4例 ,手术 +化疗 +放疗组 6 5例。局限期患者接受 2～ 4个周期化疗 ,化疗方案有COMC、COMP、COMVP和CE CAP ;放疗 4 0～ 70Gy 4～ 7周 ,照射野包括原发灶、同侧肺门、相应纵隔和双侧锁骨上。广泛期患者以化疗为主 ,姑息放疗。结果　全组CR率 2 6 .7% ,PR率 5 2 .3% ,总有效率 79.0 %。局部复发率 5 8.8% ,远处转移率 6 1.5 %。 1,3,5年生存率分别为 5 0 .2 %、14 .7%和 11.7% ,中位生存期 12个月。经单因素和多因素分析显示 ,治疗年代、性别、年龄、分期和治疗方法均有统计学意义 (P <0 .0 5 )。化疗 +放疗 +化疗组的疗效好于化疗 +放疗组 ,但差异无显著性。结论　对SCLC患者应争取早诊断早治疗 ,局限期患者应尽量争取以手术为主的综合治疗。早放疗稍好于晚放疗。Objective To evaluate the efficacy of combined modality treatment and determine the prognostic factors for small cell lung cancer (SCLC). Methods From January 1974 to December 1995, 1 260 patients with SCLC treated were retrospectively evaluated, with limited lesions in 732 patients, extensive lesions in 500 and stage unrecorded in 28. 553 patients were alloted into chemotherapy + radiotherapy (C+R) group, 355 into C+R+C group, 97 into R+C group, 126 into C group, 64 into R group and 65 into surgery (S+C+R) group. Patients with limited leisons received 2-4 cycles of chemotherapy including COMC, COMP, COMVP and CE-CAP. Radiotherapy was given to a dose of 40-70 Gy/4-7w. Radiation portals for patients with limited leisons encompassed the primary tumor, hilar lymphatic drainage areas, partial mediastinum and bilateral supraclavicular regions. Patients with extensive lesions mainly received chemotherapy with or without palliative irradiation. Results The overall CR and PR rates were 26.7% and 52.3%. Local recurrence and distant metastasis rates were 58.8% and 61.5%. The 1-, 3- and 5-year survival rates were 50.2%, 14.7% and 11.7%, with median survival time of 12 months. The era, sex, age, tumor stage and treatment modality were all significant prognostic factors by both uni-variate and multi-variate analyses (P<0.05). The result of S+C+R rated the best among these modalities and the result of C+R+C was superior to C+R, though the difference of which was not significant. Conclusion Surgical resection should be considered as one part of comprehensive therapy for small cell lung cancer patients with limited lesions whenever possible. On top of routine chemotherapy early administration of radiotherapy is advisable.

关 键 词：肺小细胞未分化癌 综合治疗 肺肿瘤 药物疗法 放射疗法 SCLC 

分 类 号：R734.2[医药卫生—肿瘤]