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目的 探讨胸部放疗在广泛期小细胞肺癌中的应用价值及对患者预后的影响.方法 回顾性分析154例广泛期小细胞肺癌患者的临床资料,化放疗组89例,化疗组65例.放疗采用常规分割1.8～2.0 Gy/次,1次/d,总剂量为40～60 Gy,化疗采用EP方案(顺铂+依托泊甙)、CE方案(卡铂+依托泊甙)或者CAO方案(环磷酰胺+阿霉素+长春新碱).结果 全组中位生存时间为13.7个月,2年和5年生存率分别为27.9%和8.1%,其中化放疗组分别为17.2个月、36.0%和10.1%,化疗组分别为9.3个月、16.9%和4.6%,两组生存率差异有统计学意义(P=0.001).全组中位无进展生存时间为8.0个月,2年和5年无进展生存率分别为13.6%和8.2%,其中化放疗组分别为10.0个月、17.4%和10.5%,化疗组分别为6.2个月、9.8%和4.9%.两组无进展生存率差异有统计学意义(P＜0.001).化放疗组胸内复发率为29.6%(21/89),化疗组胸内复发率为70.0%(42/65),差异有统计学意义(P=0.000).结论 胸部放疗能降低广泛期小细胞肺癌局部失败的发生率,延长患者的总生存时间和无进展生存时间.

Objective To evaluate the effect of thoracic radiation therapy(TRT) on patients with extensive stage small-cell lung cancer(SCLC). Methods One hundred and fifty-four patients with extensive stage SCLC treated in our department between January 2003 and December 2006 were enrolled in this study.Eighty nine patients received chemotherapy and thoracic radiation therapy(ChT/TRT),and 65 patients were treated with chemotherapy alone(ChT without TRT).The chemotherapy was CE(carboplatin and etoposide),PE(cisplatin and etoposide) or CAO(CTX,ADM and VCR) regimens.The total dose of thoracic irradiation was 40-60 Gy with 1.8-2.0 Gy per fraction. Results For the whole group,the median survival time(MST) was 13.7 months,the 2-year and 5-year overall survival rates were 27.9% and 8.1%,respectively.The MST,overall survival rates at 2 years and 5 years in the ChT/TRT group and ChT without TRT group were 17.2 months,36.0%,10.1% and 9.3 months,16.9%,4.6%,respectively(P =0.001).The median progression-free survival(PFS) for all patients was 8.0 months,the 2-year and 5-year PFS were 13.6% and 8.2%,respectively.The median PFS,2-year and 5-year PFS in the ChT/TRT group and ChT without TRT group were 10.0 months,17.4%,10.5% and 6.2 months,9.8%,4.9%,respectively(P ＜0.001).The incidence of intra-thoracic local failure was 29.6% in the ChT/TRT group and 70.0% in the ChT/without TRT group(P = 0.000). Conclusions Chemotherapy plus thoracic radiation therapy can improve the overall survival,progress free survival and reduce local regional failure rate in patients with extensive stage SCLC compared with that by chemotherapy alone.