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目的:观察分析调强适形放疗同步化疗与序贯放化疗治疗局限期小细胞肺癌的疗效、毒副反应及生活质量。方法:45例局限期小细胞肺癌患者被随机分成精确放疗加同步化疗组(同步组,23例)与化疗后再放疗组(序贯组,22例)。同步组在化疗的第1个周期开始放疗,序贯组化疗4～6个周期后再进行放疗。两组患者化疗方案均为EP方案,均接受精确放疗,1次/d,(1.8～2.0)Gy/次,5次/周,共28～31次,总剂量50.4～62.0Gy。照射野包括原发病灶和转移淋巴结。结果:同步组和序贯组原发病灶总有效率为95%和86%;12和18个月生存率分别为84%、69%和76%、34%。两组患者的毒副反应均以急性骨髓抑制、放射性食管炎及放射性肺炎为主。同步组Ⅰ～Ⅱ级放射性食管炎和放射性肺炎发生率分别为78%和86%,与序贯组的73%和81%近似。Ⅲ～Ⅳ级急性骨髓抑制发生率同步组和序贯组分别为8%、9%。生活质量QOL评分同步组和序贯组治疗前后差异无统计学意义。结论:调强适形放疗同步化疗局限期小细胞肺癌有较好的疗效,毒副反应为绝大多数患者耐受且生活质量无明显下降,但值得进一步研究。
OBJECTIVE: To observe the curative effect, side effects and quality of life of intensive-phase conformal radiotherapy and sequential chemoradiotherapy in the treatment of SCLC. Methods: Forty-five patients with minimal-stage small cell lung cancer were randomly divided into radiotherapy plus concurrent chemotherapy group (23 cases) and radiotherapy after radiotherapy group (22 cases). In the synchronization group, radiotherapy was started in the first cycle of chemotherapy, followed by radiotherapy in 4 to 6 cycles of sequential chemotherapy. The two groups of patients with chemotherapy are EP regimen, are receiving precise radiotherapy, 1 / d, (1.8 ~ 2.0) Gy / times, 5 times / week, a total of 28 to 31 times, a total dose of 50.4 ~ 62.0Gy. Radiation field, including primary lesions and metastatic lymph nodes. Results: The total effective rates of the primary and the sequential group were 95% and 86% respectively; the survival rates at 12 and 18 months were 84%, 69%, 76% and 34% respectively. Toxic side effects in both groups were mainly acute myelosuppression, radiation esophagitis and radiation pneumonitis. The incidence of radiation esophagitis and radiation pneumonitis in group Ⅰ ~ Ⅱ of synchronous group was 78% and 86% respectively, which was similar to 73% and 81% of the sequential group. The incidence of grade Ⅲ ~ Ⅳ acute myelosuppression was 8% and 9% in the synchronous group and the sequential group, respectively. Quality of life QOL score synchronization group and sequential group before and after treatment there was no significant difference. Conclusions: IMRT regimen has better curative effect on NSCLC. Toxicity and side effects are the most tolerable and no significant decrease of quality of life in patients. However, it is worth further study.