CAJ | 학술논문

目的评价胸部3DCRT在广泛期SCLC中的价值.方法选择2004-2009年间收治的171例广泛期SCLC患者纳入研究,其中86例接受胸部3DCRT和全身化疗,85例只接受全身化疗.放疗采用超分割(1.5 Gy/次,2次/d)或常规分割(2.0Gy/次,1次/d)方式,总量40 ～62Gy.化疗方案为铂类联合依托泊甙.生存计算采用Kaplan-Meier法并Logrank检验和单因素预后分析,Cox模型多因素预后分析.结果随访率为100％.全组中位OS期、2年OS率、5年OS率全组分别为15个月、31.5％、2.4％,放疗组的分别为18个月、35.3％、2.4％,化疗组的分别为12个月、14.5％、2.4％(P =0.023).全组中位PFS期、1年PFS率、2年PFS率全组分别为8个月、27.5％、2.4％,放疗组的分别为9个月、35.4％、6.0％,化疗组的分别为6个月、20.5％、6.0％(P=0.004).放疗组中超分割总量45 Gy的22例患者中位PFS期11个月,常规分割总量60Gy的26例患者中位PFS期9个月(P=0.037).多因素分析显示3DCRT、4周期以上化疗是预后有利因素(P=0.008、0.001).结论胸部放疗能改善广泛期SCLC患者OS和PFS,总量45Gy超分割放疗较佳.胸部放疗和4周期以上化疗对OS是独立的预后有利因素.
목적 평개흉부3DCRT재엄범기SCLC중적개치.방법 선택2004-2009년간수치적171례엄범기SCLC환자납입연구,기중86례접수흉부3DCRT화전신화료,85례지접수전신화료.방료채용초분할(1.5 Gy/차,2차/d)혹상규분할(2.0Gy/차,1차/d)방식,총량40 ～62Gy.화료방안위박류연합의탁박대.생존계산채용Kaplan-Meier법병Logrank검험화단인소예후분석,Cox모형다인소예후분석.결과 수방솔위100％.전조중위OS기、2년OS솔、5년OS솔전조분별위15개월、31.5％、2.4％,방료조적분별위18개월、35.3％、2.4％,화료조적분별위12개월、14.5％、2.4％(P =0.023).전조중위PFS기、1년PFS솔、2년PFS솔전조분별위8개월、27.5％、2.4％,방료조적분별위9개월、35.4％、6.0％,화료조적분별위6개월、20.5％、6.0％(P=0.004).방료조중초분할총량45 Gy적22례환자중위PFS기11개월,상규분할총량60Gy적26례환자중위PFS기9개월(P=0.037).다인소분석현시3DCRT、4주기이상화료시예후유리인소(P=0.008、0.001).결론 흉부방료능개선엄범기SCLC환자OS화PFS,총량45Gy초분할방료교가.흉부방료화4주기이상화료대OS시독립적예후유리인소.
Objective To evaluate the role of thoracic three-dimensional conformal radiotherapy (3DCRT) in patients with extensive-stage small cell lung cancer (ES-SCLC).Methods A total of 171 patients with ES-SCLC admitted from 2004 to 2009 were included in the study.Eighty-six patients received thoracic 3DCRT and systemic chemotherapy (CT),while 85 patients received systemic CT alone.3DCRT was delivered at 1.5 Gy/fraction twice daily or 2.0 Gy/fraction once daily,with a total dose ranging from 40 to 62 Gy.The CT regimen consisted of carboplatin/cisplatin and etoposide.The survival time and survival rate were calculated by the Kaplan-Meier method,and the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％.The median overall survival (OS) time and the 2-and 5-year OS rates were 15 months,31.5％,and 2.4％,respectively,for all patients;they were 18 months,35.3％,and 2.4％,respectively,for the CT/3DCRT group,versus 12 months,14.5％,and 2.4％ for the CT group (P =0.023).The median progression-free survival (PFS) time and the 1-and 2-year PFS rates were 8 months,27.5％,and 2.4％,respectively,for all patients;they were 9 months,35.4％,and 6.0％,respectively,for the CT/3DCRT group,versus 6 months,20.5％,and 6.0％ for the CT group (P =0.004).In the CT/3DCRT group,the 22 patients who received 45 Gy at 1.5 Gy/fraction twice daily had a median PFS time of 11 months,versus 9 months for the 26 patients who received 60 Gy at 2.0 Gy/fraction once daily (P =0.037).Multivariate analysis revealed that receiving ≥ 4 cycles of CT (P =0.001) and 3DCRT (P =0.008) were favorable prognostic factors for OS.Conclusions Thoracic 3DCRT can improve the OS and PFS in patients with EDSCLC,and it has good efficacy when delivered with a total dose of 45 Gy at 1.5 Gy/fraction twice daily.Thoracic 3DCRT and receiving ≥4 cycles of CT are independent favorable prognostic factors for OS.