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目的小细胞肺癌根治术后巩固化疗后预防性脑照射是否能减低脑转移率,提高生存率。方法1978年3月~1994年7月收治了小细胞肺癌术后化疗后脑预防照射25例。男18例,女7例。术后病理分期Ⅰ,Ⅱ,ⅢA分别为8,8和9例。化疗方案:COME(C:环磷酰胺;O:长春新硷;M:甲氨蝶呤;E:依托泊甙),COMC(C:环磷酰胺;O:长春新硷;M:甲氨蝶呤;C:卡铂),CAE(C:环磷酰胺;A:阿霉素;E:依托泊甙),CECAP(C:卡铂;E:依托泊甙;C:环磷酰胺;A:阿霉素;P:顺铂)。24Gy照射3例,30Gy照射22例。同期根治术后化疗后未作脑预防照射45例作对照。结果脑转移率:预防组8%(2/25),对照组20%(9/45)。预防组1,3,5年生存率分别为88.0%,60.0%和47.4%。对照组分别为73.3%,42.2%和34.2%。预防组Ⅰ,Ⅱ,ⅢA期5年生存率分别为60.0%,57.0%和28.6%,对照组的分别为57.0%,30.8%和9.0%。结论小细胞肺癌预防性脑照射有可能减低脑转移率,提高生存率,但因病例数少不能下结论。
Objective To confirm whether prophylactic brain irradiation after chemotherapy for small cell lung cancer can reduce the rate of brain metastasis and improve survival. METHODS: From March 1978 to July 1994, 25 patients with small cell lung cancer received brain irradiation after chemotherapy. 18 males and 7 females. Postoperative pathological stage I, II, IIIA were 8, 8 and 9 cases respectively. Chemotherapy regimen: COME (C: Cyclophosphamide; O: Changchun Xinxuan; M: Methotrexate; E: Etoposide), COMC (C: Cyclophosphamide; O: Changchun Xinhao; M: Methionine) (C: cyclophosphamide; A: doxorubicin; E: etoposide), CE-CAP (C: carboplatin; E: etoposide; C: cyclophosphamide; A: doxorubicin; P: cisplatin). 24Gy irradiation in 3 cases, 30Gy irradiation in 22 cases. In the same period, 45 cases of cerebral prophylactic irradiation after radical chemotherapy were used as controls. Results Brain metastasis rate: 8% (2/25) in the prevention group and 20% (9/45) in the control group. The 1-, 3-, and 5-year survival rates in the prevention group were 88.0%, 60.0%, and 47.4%, respectively. The control group was 73.3%, 42.2% and 34.2%, respectively. The 5-year survival rates of the prophylaxis group I, II, and III A were 60.0%, 57.0%, and 28.6%, respectively, and those in the control group were 57.0%, 30.8%, and 9.0%, respectively. Conclusion Prophylactic brain irradiation for small cell lung cancer may reduce the rate of brain metastasis and increase survival rate, but it cannot be concluded because of the small number of cases.