摘要
目的分析临床Ⅰ、Ⅱ期小细胞肺癌的治疗情况,评价手术和非手术综合治疗的疗效和预后因素。方法共收治经病理和细胞学证实的局限期小细胞肺癌358例,其中89例为临床Ⅰ、Ⅱ期病例,55例行手术＋化疗±放疗,34例行化放化疗。化疗以PE、CAP方案为主,一般疗程为4～6个周期。放疗采用6 MV X线照射,包括原发灶、肺门及相应纵隔,总量达56～60 Gy,5～6周。结果总中位生存时间为48个月,1、2、3、5年生存率分别为95%、71%、57%、48%。手术＋化疗±放疗组中位生存时间为50个月,1、2、3、5年生存率分别为96%、70%、58%、52%;失败原因包括局部复发（4%）、远处转移（31%）、局部复发加远处转移（9%）和脑转移（18%）。化放化疗组的中位生存时间为40个月,1、2、3、5年生存率分别为94%、74%、55%、40%;失败原因包括局部复发（12%）、远处转移（44%）、局部复发加远处转移（6%）和脑转移（29%）。手术＋化疗±放疗组与化放化疗组的生存率差异无统计学意义（P=0．404）。脑转移对预后有明显影响（P=0．001）。结论手术＋化疗±放疗和化放化疗对临床Ⅰ、Ⅱ期小细胞肺癌的治疗均有较好的疗效和预后。远处转移是失败的主要原因。脑转移发生率较高。建议术后及放化疗后达CR者进行脑预防性照射。
Objective To evaluate the u＇eatment effects of surgery plus chemotherapy （ ＋ radiotherapy） compared with combined chemotherapy and radiotherapy for clinical staged Ⅰ and Ⅱ small cell lung cancer （SCLC）. Methods Out of 358 patients with limited small cell lung cancer, proved cyto-pathologically, 89 patients with clinical stage Ⅰ or Ⅱ disease made up the material of this paper. Fifty-five patients received surgery and adjuvant chemotherapy with or without radiotherapy （surgery group）. Thirty-four patients were treated by non-surgery method： ie combined chemotherapy and radiotherapy （non-surgery group）. The chemotherapy regimen included PE （ or CE）, CAP or CAV for 4-6 cycles. Irradiation treatment covering the primary tumor, the ipsilateral hilar nodes and mediastinum was delivered once-daily with 6 megavoltage X-ray beam to a median irradiation dose of 58 Gy （56-60 Gy） was given in 5-6 weeks. Resuits The overall median survival time （MST） was 48 months. The 1-, 2-, 3-, and 5-year overall survival rates were 95%, 71%, 57%, and 48%. In the surgery group, the median survival time （MST） was 50 months. The 1-, 2-, 3-, and 5-year survival rates were 96%, 70%, 58%, and 52%. Failure in the surgical group included local recurrence （4%）, distant metastasis （31%）, both local and distant failure （9%）, and brain metastasis （18%）. In the non-surgery group, the MST was40 months. The 1-, 2-, 3-, and 5-year survival rates were 94%, 74%, 55%, and 40%. Failure included local recurrence （ 12% ）, distant metastasis （44%）, both local and distant failure （6%）, and brain metastasis（29% ）. There was no significant difference in the overall survival rates between the two groups （X^2 = 0.70, P = 0.404）. Cox regression analysis showed that brain metastasis was an influential factor of prognosis （ P = 0.001 ）. Conclusions For clinical stage Ⅰ and Ⅱ SCLC, both surgery plus chemotherapy （or radiotherapy） or combined chemotherapy and radiotherapy without surgery could achieve a satisfactory treatment result. The distant metastasis is the mainstay of treatment failure. For patients who achieved CR after surgery and chemotherapy, prophylactic cranial irradiation is suggested because of since the high rate of brain metastasis.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2007年第3期182-186,共5页
Chinese Journal of Radiation Oncology
关键词
癌
小细胞肺/外科学
癌
小细胞肺/放射疗法
癌
小细胞肺/化学疗法
综合治疗
Carcinoma,small cell lung/surgery
Carcinoma, small cell lung/radiotherapy
Carcinoma,small cell lung/chemotherapy
Combined modality therapy
作者简介
通讯作者
