CAJ | 학술논문

目的开展广泛期小细胞肺癌化疗有效的患者进行全脑预防照射及颅外病变放疗的前瞻性研究,评价疗效和不良反应.方法 2010-2012年入组30例病理或细胞学确诊、经4～6周期PE或CE方案化疗有效的广泛期小细胞肺癌患者接受颅外病灶放疗(50 ～ 60 Gy/25～ 30次)及全脑预防性照射(25 Gy/10次).采用RECIST1.1标准评估近期疗效、CTC3.0AE及RTOG放射损伤分级标准评价不良反应.结果全组共29例按计划完成颅外病灶放疗及全脑预防性照射.完全缓解率13％、部分缓解率27％、稳定率60％,疾病控制率100％.16例治疗有效后进展,其中单纯局部区域失败1例、远处失败15例(单纯远处失败9例,局部区域+远处转移6例,共4例脑转移).随访率100％,1年局部区域失败率、远处失败率分别为24％、51％,1年生存率、无瘤生存率分别为71％、37％.急性不良反应中≥2级血液学改变、放射性食管炎分别占33％、13％.结论广泛期小细胞肺癌化疗有效者行全脑预防照射及颅外病灶放疗近期疗效较好且耐受放疗,可减少颅内转移及局部复发率,但最终尚需扩大病例进一步研究.
목적 개전엄범기소세포폐암화료유효적환자진행전뇌예방조사급로외병변방료적전첨성연구,평개료효화불량반응.방법 2010-2012년입조30례병리혹세포학학진、경4～6주기PE혹CE방안화료유효적엄범기소세포폐암환자접수로외병조방료(50 ～ 60 Gy/25～ 30차)급전뇌예방성조사(25 Gy/10차).채용RECIST1.1표준평고근기료효、CTC3.0AE급RTOG방사손상분급표준평개불량반응.결과 전조공29례안계화완성로외병조방료급전뇌예방성조사.완전완해솔13％、부분완해솔27％、은정솔60％,질병공제솔100％.16례치료유효후진전,기중단순국부구역실패1례、원처실패15례(단순원처실패9례,국부구역+원처전이6례,공4례뇌전이).수방솔100％,1년국부구역실패솔、원처실패솔분별위24％、51％,1년생존솔、무류생존솔분별위71％、37％.급성불량반응중≥2급혈액학개변、방사성식관염분별점33％、13％.결론 엄범기소세포폐암화료유효자행전뇌예방조사급로외병조방료근기료효교호차내수방료,가감소로내전이급국부복발솔,단최종상수확대병례진일보연구.
Objective To investigate the efficacy and safety of thoracic radiotherapy (TR) and prophylactic cranial irradiation (PCI) in patients with extensive small cell lung cancer (SCLC) who show response to chemotherapy.Methods From July 2010 to March 2012,30 patients with a pathological or cytological diagnosis of extensive SCLC who showed response to 4-6 cycles of chemotherapy with carboplatin plus etoposide or chemotherapy with cisplatin plus etoposide were included in the study.The median age of patients was 57 years (range,40-71 years).All the patients received TR (50---60 Gy) and PCI (25Gy).The short-term efficacy was assessed by RECIST 1.1,and the toxicities were evaluated according to CTCAE 3.0 and RTOG radiation morbidity scoring criteria.Results Twenty-nine of the 30 patients completed the TR and PCI.Of these patients,13％ showed complete remission,27％ showed partial remission,and 60％ showed stable disease,and the disease control rate was 100％.Progression was seen in 16 patients after effective treatment,including 1 patients with locoregional failure (LRF) alone and 15patients with distant failure (DF) (9 patients with DF alone and 6 patients with locoregional and distant metastases,4 patients with brain metastasis).The follow-up rate was 100％.The 1-year LRF rate and DF rate were 24％ and 51％,respectively.The 1-year overall survival rate and disease-free survival rate were 71％ and 37％,respectively.The acute toxicities included grade ≥2 hematological toxicity and grade ≥ 2radiation esophagitis,which occurred in 33％ and 13％ of all patients.Conclusions TR and PCI have good short-term efficacy and safety in extensive SCLC patients with response to chemotherapy and can reduce brain metastases and local recurrence.However,further study is needed with a larger sample.