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目的:通过复习局限期小细胞肺癌(SCLC)放射治疗的文献,探讨局限期SCLC最佳放射治疗策略。方法:应用计算机检索PubMed和CHKD数据库有关SCLC放射治疗的70篇研究文章,纳入分析39篇,检索词为小细胞肺癌、局限期、放射治疗和预防性脑照射。结果:试验表明放射治疗优于手术治疗,中位总生存期手术组为6个月,放疗组为10个月,差异有统计学意义;Meta分析显示,联合化疗+放疗较单纯联合化疗方法改善了生存期,单纯联合化疗组患者3年生存率为8.9%,联合化疗+放疗组3年生存率为14.3%,P=0.001。预防性脑照射(PCI)的作用已肯定。但是,胸部照射(thoracic radiation therapy,TRT)的剂量、时机和靶体积等问题未完全解决。结论:局限期SCLC的治疗策略为化疗和同步TRT以及预防性脑照射(PCI)。胸部照射应该在化疗早期(化疗第1或2个周期)进行,不赞同根据化疗前肿瘤体积来确定照射靶区。PCI应尽可能在化疗完成后就开始。
OBJECTIVE: To investigate the optimal radiotherapy strategies for SCLC in patients with limited-stage SCLC. Methods: A computer-based search of PubMed and CHKD databases was performed in 70 articles on SCLC radiotherapy. 39 articles were included in the analysis. The search terms were small cell lung cancer, localization, radiotherapy, and prophylactic brain irradiation. Results: The results showed that radiotherapy was better than surgical treatment. The median overall survival was 6 months in the surgery group and 10 months in the radiotherapy group. The meta-analysis showed that the combination chemotherapy + radiotherapy was better than the combined chemotherapy alone. In the survival period, the 3-year survival rate was 8.9% in the simple combination chemotherapy group and 14.3% in the combined chemotherapy + radiotherapy group, P=0.001. The role of prophylactic brain irradiation (PCI) has been affirmed. However, the dose, timing, and target volume of thoracic radiation therapy (TRT) have not been completely solved. CONCLUSIONS: The treatment strategies for confined SCLC are chemotherapy and concurrent TRT and prophylactic brain irradiation (PCI). Chest irradiation should be performed in the early stage of chemotherapy (1 or 2 cycles of chemotherapy), and it is unfavorable to determine the irradiation target area based on the tumor volume before chemotherapy. PCI should begin as soon as possible after chemotherapy is complete.