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背景与目的:局限期小细胞肺癌(small cell lung cancer,SCLC)对放疗和化疗均敏感。放疗可提高局限期SCLC患者总生存率,降低局部复发率。本研究总结在化疗基础上应用加速超分割放射治疗(hyperfractionated accelerated radiotherapy,HART)对局限期SCLC的疗效,评价相关治疗毒性,归纳治疗失败方式。方法:55例局限期SCLC患者经过EP方案诱导化疗,放疗后再以EP方案巩固化疗,完全缓解(complete remission,CR)者行预防性全脑照射(prophylactic cranial irradiation,PCI)。治疗结束后对患者进行随访,并评价其疗效及毒副作用。结果:55例患者放化疗结束时总有效率(CR+PR)为87.3%。1、3、5年总生存率分别为79.1%、40.3%、16.1%,中位生存时间18.7个月。Ⅲ度和Ⅳ度血液学毒性分别为23例(41.8%)和16例(29.1%);Ⅰ度和Ⅱ度急性放射性肺炎分别为21例(38.2%)和2例(3.6%),Ⅰ度和Ⅱ度放射性食管炎分别为29例(52.7%)和12例(21.8%),未发生Ⅲ～Ⅳ度非血液学毒性。11例(20.0%)患者出现Ⅰ度肺纤维化,5例(9.1%)为Ⅱ度。2例(3.6%)发生Ⅰ度后期食管损伤。16例(29.1%)局部/区域复发,21例(38.2%)发生远处转移。结论:EP方案化疗合并HART治疗局限期SCLC毒性轻至中度,患者可以耐受。局部复发和远处转移为主要治疗失败原因。
BACKGROUND & AIM: Localized small cell lung cancer (SCLC) is sensitive to radiotherapy and chemotherapy. Radiotherapy can increase the overall survival of patients with localized SCLC and reduce the local recurrence rate. This study summarizes the efficacy of accelerated hyperfractionated accelerated radiotherapy (HART) on localized SCLC based on chemotherapy, and evaluates the related therapeutic toxicity and summarizes the failure modes of treatment. Methods: Fifty-five patients with locally advanced SCLC undergoing induction chemotherapy were treated with EP regimen, followed by chemotherapy with EP regimen after radiotherapy and prophylactic cranial irradiation (PCI) with complete remission (CR). After treatment, patients were followed up, and evaluated its efficacy and side effects. Results: The total effective rate (CR + PR) of the 55 patients at the end of radiotherapy and chemotherapy was 87.3%. The overall survival rates at 1, 3 and 5 years were 79.1%, 40.3% and 16.1%, respectively. The median survival time was 18.7 months. Grade III and IV hematological toxicities were 23 (41.8%) and 16 (29.1%), respectively; 21 (38.2%) and 2 (3.6% And Ⅱ degrees of esophagitis were 29 cases (52.7%) and 12 cases (21.8%), did not occur Ⅲ ~ Ⅳ non-hematological toxicity. Grade I pulmonary fibrosis occurred in 11 patients (20.0%) and grade II in 5 patients (9.1%). Two cases (3.6%) of grade Ⅰ esophageal injury. 16 cases (29.1%) local / regional recurrence, 21 cases (38.2%) distant metastasis. CONCLUSIONS: EP regimen combined with HART has mild to moderate toxicity in SCLC and can be tolerated. Local recurrence and distant metastasis as the main cause of treatment failure.