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背景与目的小细胞肺癌(small cell lung cancer,SCLC)具有高度化疗敏感性,耐药患者不足15%,本研究拟通过回顾性分析诱导化疗无效的局限期SCLC患者放化疗次序和放疗时机与无进展生存期(progression-free survival,PFS)及总体生存(overall survival,OS)的相关性,以探索同期放化疗是否优于序贯放化疗。方法收集2009年1月-2014年12月初治的67例诱导化疗无效的局限期SCLC,分为同期放化疗组32例与序贯放化疗组35例。94%患者临床分期为Ⅲ期,6%患者为Ⅰb期-Ⅱb期。25例行脑预防性照射(prophylactic cranial irradiation,PCI)。Kaplan-Meier法计算生存率并Log-rank法检验,组间分类数据行卡方检验。结果全组2年OS、PFS及局部控制(local control rate,LCR)分别为53.7%、20.9%和58.2%。同期放化疗组与序贯放化疗组2年OS分别为37.5%和54.3%(P=0.048)、2年PFS分别为12.5%与28.6%(P=0.149)。同期放化疗组中,13例患者(40.6%)同步化疗方案改为二线化疗方案,19例患者仍为EP或EC方案,二者2年OS分别为53.8%与26.3%(P=0.741)。同期放化疗组血液学毒性反应多于序贯放化疗组(P=0.031)、3级放射性食管炎、放射性肺炎及胃肠道反应有增多的趋势(9.4%vs 0,P=0.176;12.5%vs 2.9%,P=0.318;12.5%vs 2.9%,P=0.109)。PCI与否2年OS分别为56.0%和38.1%(P=0.029)、PFS分别为24%和19%(P=0.012)。结论诱导化疗无效的局限期SCLC可能不宜继续原方案同期放化疗,可以换用二线方案或者进行单纯放疗,由于是回顾性小样本研究,此结论还需进一步的大样本前瞻性研究证实。
BACKGROUND & AIM: Small cell lung cancer (SCLC) is highly chemosensitive and resistant to less than 15% of patients. This study was designed to retrospectively analyze the sequence of chemoradiation and the timing of radiotherapy and chemotherapy in patients with locally advanced SCLC who are refractory to induction chemotherapy Progression-free survival (PFS) and overall survival (OS) in order to explore whether concurrent radiochemotherapy is better than sequential chemoradiotherapy. Methods Sixty-six SCLC patients with ineffective induction chemotherapy were collected from January 2009 to December 2014. They were divided into two groups: 32 in the same period of radiotherapy and chemotherapy and 35 in the sequential radiotherapy and chemotherapy group. 94% of patients with clinical stage Ⅲ, 6% of patients with stage Ⅰ b-Ⅱ b. 25 patients underwent prophylactic cranial irradiation (PCI). Kaplan-Meier method was used to calculate the survival rate and log-rank test, and the inter-group classification data were tested by chi-square test. Results The 2-year OS, PFS and local control rate (LCR) were 53.7%, 20.9% and 58.2% respectively. The two-year OS was 37.5% and 54.3% (P = 0.048) in the concurrent chemoradiation and sequential radiochemotherapy groups, respectively, with a 2-year PFS of 12.5% and 28.6%, respectively (P = 0.149). In the concurrent chemoradiotherapy group, 13 patients (40.6%) underwent synchronous chemotherapy instead of the second-line chemotherapy, and 19 patients remained on the EP or EC regimen. The two-year OS was 53.8% and 26.3% respectively (P = 0.741). The hematological toxicities of radiotherapy and chemotherapy group were higher than those of sequential radiotherapy and chemotherapy group (P = 0.031), grade 3 radiation esophagitis, radiation pneumonitis and gastrointestinal reaction (9.4% vs 0, P = 0.176; 12.5% vs 2.9%, P = 0.318; 12.5% vs 2.9%, P = 0.109). The 2-year OS was 56.0% and 38.1%, respectively, with PFS of 24% and 19%, respectively (P = 0.012). Conclusions SCLC, which is not effective in inducing chemotherapy, may not be suitable for chemoradiotherapy during the same period. The second-line regimen or radiotherapy may be used instead. As a retrospective small-sample study, further large-scale prospective studies are needed to confirm this conclusion.