CAJ | 학술논문

目的观察三维适形放疗(3DCRT)同步化疗对局限期小细胞肺癌(LSCLC)的疗效及毒副反应.方法 93例LSCLC患者随机分为3DCRT组(46例)和常规组(47例),均先顺铂+足叶乙甙或卡铂+足叶乙甙方案化疗1周期,再同步放化疗,然后继续化疗,共4-6周期.达完全缓解者给予脑预防照射30 Gy分10次.常规组按常规设野,3DCRT组只包括原发灶、转移淋巴结及邻近一站淋巴引流区.放疗2 Gy/次,5次/周,共60～64 Gy.结果 3DCRT组和常规组随访率分别为100%和100%,随访时间满1、2、3年者分别为36和34、16和14、7和8例.3DCRT组和常规组完全缓解率分别为52%和47%,有效率分别为89%和85%(χ~2=0.34,P=0.759).3DCRT组和常规组1、2,3年生存率分别为78%和72%、35%和30%、15%和17%(χ~2=0.18,P=0.92),中位生存期分别为23.2和22.8个月.三维适形放疗组1+2级早期放射性肺和食管反应、1+2、3级晚期放射性肺损伤均轻于常规放疗组,两组均无3、4级早期肺和食管反应,以及4级晚期肺损伤;1+2、3、4级急性骨髓抑制两组相似.结论 3DCRT同步化疗用于LSCLC治疗可获得满意的近、远期疗效,毒副反应小,有较高的临床可行性.
목적 관찰삼유괄형방료(3DCRT)동보화료대국한기소세포폐암(LSCLC)적료효급독부반응.방법 93례LSCLC환자수궤분위3DCRT조(46례)화상규조(47례),균선순박+족협을대혹잡박+족협을대방안화료1주기,재동보방화료,연후계속화료,공4-6주기.체완전완해자급여뇌예방조사30 Gy분10차.상규조안상규설야,3DCRT조지포괄원발조、전이림파결급린근일참림파인류구.방료2 Gy/차,5차/주,공60～64 Gy.결과 3DCRT조화상규조수방솔분별위100%화100%,수방시간만1、2、3년자분별위36화34、16화14、7화8례.3DCRT조화상규조완전완해솔분별위52%화47%,유효솔분별위89%화85%(χ~2=0.34,P=0.759).3DCRT조화상규조1、2,3년생존솔분별위78%화72%、35%화30%、15%화17%(χ~2=0.18,P=0.92),중위생존기분별위23.2화22.8개월.삼유괄형방료조1+2급조기방사성폐화식관반응、1+2、3급만기방사성폐손상균경우상규방료조,량조균무3、4급조기폐화식관반응,이급4급만기폐손상;1+2、3、4급급성골수억제량조상사.결론 3DCRT동보화료용우LSCLC치료가획득만의적근、원기료효,독부반응소,유교고적림상가행성.
Objective To evaluate therapeutic effects and complications of concurrent three-dimensional conformal radiotherapy (3DCRT) and chemotherapy in patients with limited-stage small cell lung cancer (LSCLC).Methods From June 2000 to August 2005, 93 histologically proved LSCLC patients were randomized into two groups:3DCRT group (n =46) and conventional group (n =47).In both groups, patients received one cycle chemotherapy, followed by concurrent chemoradiotherapy and then received consolidate chemotherapy.Chemotherapy was four to six cycles of PE regimen.Conventional irradiation field was setup in conventional group, while in 3 DCRT group clinical target volume (CTV) only involved visible tumor and adjacent lymphatic region.Radiotherapy was delivered at 2 Gy per fraction, 5 fractions per week to a median total dose of 60 -64 Gy.Those who achieved a complete response were treated with prophylactic cranial irradiation (PCI) with 30 Gy in 10 fractions.Results The follow-up rate was 100% in both groups.The number of patients completed 1-, 2-and 3-year follow-up were 36, 34 and 16 in 3DCRT group, 14, 7 and 8 in conventional group, respectively.The complete and overall response rate were 52% and 89% in 3DCRT group, while 47% and 85% in conventional group, respectively.The 1-, 2-and 3-year survival rates were 78%, 35% and 15% in 3DCRT group, 72%, 30% and 17% in conventional group, respectively.The median survival time was 23.2 and 22.8 months, respectively.There was no statistical difference in short-term (Χ~2 = 0.34 ,P = O.759) and long-term outcomes (Χ~2 = 0.18 ,P = 0.92).In 3DCRT group, the incidence of grade 1 +2 acute radiation pneumonitis and esophagitis, grade 1 +2 and grade 3 chronic radiation pneumonitis were lower than those in conventional group.There was no grade 3 or 4 acute radiation pneumonitis or esophagitis, or grade 4 chronic radiation pneumonitis in both groups.There was no difference in grade 1 + 2, grade 3 or grade 4 acute myelo-suppression between the two groups.Conclusions In the treatment of LSCLC, concurrent 3DCRT and chemotherapy can achieve satisfactory short-term and long-term outcomes with acceptable complications.