Dong Xiao-jiao, Wang Meng-zhao, Zhong Wei, Zhang Li, Zhang Xiao-tong, Zhao Jing, Xia Ying, Li Long-yun
Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Zhong Liu Za Zhi. 2012 Mar;34(3):216-21. doi: 10.3760/cma.j.issn.0253-3766.2012.03.013.
To study the differences of objective response rate (ORR), side effects and survival among patients with limited-stage small cell lung cancer (LD-SCLC), who received concurrent chemoradiotherapy, sequential chemoradiotherapy or chemotherapy alone, and to analyze the influencing factors on their survival.
One hundred and sixty-six patients diagnosed as LD-SCLC in Peking Union Medical College Hospital from January 2000 to December 2009 were included in this study. The differences of objective response rates, side effects and survival rates were analyzed by χ2 test. Kaplan-Meier test was used to calculate the overall survival (OS) and progress-free survival (PFS). Cox regression was used to detect the influencing factors on survival time of the patients.
The patients were divided into three groups: concurrent chemoradiotherapy (49 cases), sequential chemoradiotherapy (62 cases) and chemotherapy alone (55 cases). The chemotherapy was based on CE/EP regimen, with an average cycle of 5.2. Radiotherapy was of a common or 3-dimensional conformal technology, for regular segmentation irradiation with an average dose of 49.6 Gy. The total ORR was 73.4%, OS and PFS were 22.9 months and 10.8 months, 1, 3, 5-year survival rates were 82.7%, 31.8%, 18.6%, respectively. For the concurrent group, sequential group and chemotherapy alone group, the ORR was 89.4%, 67.2% and 66.0%, respectively. Compared the chemotherapy alone group and concurrent group with the sequential group, there were significant differences (P<0.05). For the concurrent group, sequential group and chemotherapy alone group, the median OS was 29.7 months, 22.6 months, and 19.5 months; the median PFS was 12.7 months, 10.8 months, and 9.8 months, respectively, with a non-significant difference between each two groups (P>0.05). For the concurrent group, sequential group and chemotherapy alone group, the 1-year survival rates were 91.1%, 86.3%, and 65.6%, the 3-year survival rates were 44.2%, 28.3% and 22.8%, and the 5-year survival rates were 24.2%, 21.4% and 11.1%, respectively, with significant differences among them (P<0.05). The major side effects were myelosuppression, gastrointestinal reactions, radiation pneumonia and radiation esophagitis. For the concurrent group, sequential group and chemotherapy alone group, the incidence of myelosuppression were 84.4%, 76.8% and 60.0%, respectively, with a significant difference (P=0.008) between the concurrent group and chemotherapy alone group. For the concurrent group and sequential group, the incidences of radiation pneumonia were 22.2% and 22.9%, with a non-significant difference (P=0.940). The incidences of radiation esophagitis were 47.2% and 16.7%, respectively, with a significant difference (P=0.002). Multivariate analysis showed that OS was significantly associated with gender (P=0.018) and ECOG score (P=0.009), and PFS was significantly associated with gender (P=0.050).
For LD-SCLC, concurrent chemoradiotherapy can significantly increase the objective response rate. Concurrent chemoradiotherapy and sequential chemoradiotherapy compared with chemotherapy alone can extend survival, and concurrent chemoradiotherapy is better, but the differences among the three regimens are not significant. Gender and ECOG score are important influencing factors of survival.
研究局限期小细胞肺癌（LD-SCLC）患者接受同步放化疗、序贯放化疗或单纯化疗时的客观缓解率（ORR）、副作用及生存率差异，并分析其生存的影响因素。
纳入2000年1月至2009年12月在北京协和医院确诊为LD-SCLC的166例患者。采用χ2检验分析客观缓解率、副作用及生存率的差异。采用Kaplan-Meier检验计算总生存期（OS）和无进展生存期（PFS）。采用Cox回归检测患者生存时间的影响因素。
患者分为三组：同步放化疗组（49例）、序贯放化疗组（62例）和单纯化疗组（55例）。化疗采用CE/EP方案，平均周期为5.2个周期。放疗采用常规或三维适形技术，进行常规分割照射，平均剂量为49.6 Gy。总ORR为73.4%，OS和PFS分别为22.9个月和10.8个月，1年、3年、5年生存率分别为82.7%、31.8%、18.6%。同步放化疗组、序贯放化疗组和单纯化疗组的ORR分别为89.4%、67.2%和66.0%。单纯化疗组和同步放化疗组与序贯放化疗组比较，差异有统计学意义（P<0.05）。同步放化疗组、序贯放化疗组和单纯化疗组的中位OS分别为29.7个月、22.6个月和19.5个月；中位PFS分别为12.7个月、10.8个月和9.8个月，两两比较差异无统计学意义（P>0.05）。同步放化疗组、序贯放化疗组和单纯化疗组的1年生存率分别为91.1%、86.3%和65.6%，3年生存率分别为44.2%、28.3%和22.8%，5年生存率分别为24.2%、21.4%和11.1%，差异有统计学意义（P<0.05）。主要副作用为骨髓抑制、胃肠道反应、放射性肺炎和放射性食管炎。同步放化疗组、序贯放化疗组和单纯化疗组的骨髓抑制发生率分别为84.4%、76.8%和60.0%，同步放化疗组与单纯化疗组比较差异有统计学意义（P=0.008）。同步放化疗组和序贯放化疗组的放射性肺炎发生率分别为22.2%和22.9%，差异无统计学意义（P=0.940）。放射性食管炎发生率分别为47.2%和16.7%，差异有统计学意义（P=0.002）。多因素分析显示，OS与性别（P=0.018）和ECOG评分（P=0.009）显著相关，PFS与性别（P=0.050）显著相关。
对于LD-SCLC，同步放化疗可显著提高客观缓解率。同步放化疗和序贯放化疗与单纯化疗相比可延长生存期，且同步放化疗更佳，但三种方案之间差异无统计学意义。性别和ECOG评分是生存的重要影响因素。
