Wang Zhen-Bo, Ning Fang-Ling, Wang Xiao-Le, Cheng Yu-Feng, Dong Xin-Jun, Liu Chang-Min, Chen Shao-Shui
Department of Oncology, Binzhou Medical University Hospital Shandong, China.
Oncology Center, Qilu Hospital of Shandong University Shandong, China.
Int J Clin Exp Med. 2015 Mar 15;8(3):4263-8. eCollection 2015.
Approximately 10% of small cell lung cancer (SCLC) cases develop superior vena cava syndrome (SVCS). Many SCLC patients with SVCS have relatively limited disease, requiring curative rather than palliative treatment. Besides chemotherapy, radiotherapy is important for treating SCLC with SVCS. We retrospectively evaluated the influence of radiotherapy dose on the prognosis of 57 patients with SCLC with SVCS treated with concurrent chemoradiotherapy. The mean biological equivalent radiation dose was 71.5 Gy. We administered etoposide/cisplatin as sequential and concurrent chemotherapy. All patients received at least one cycle of concurrent chemotherapy. All patients had partial or complete response; SVCS-associated symptoms were reduced in 87.7% (50/57) of patients within 3-10 days after treatment. Radiation dose did not affect 2-year local control (74.2% vs. 80.8%). Patients who received high-dose radiation had a lower 2-year overall survival rate than those who received low-dose radiation (11.6 vs. 33%; P = 0.024). The high dose group median survival was 15.0 months (95% confidence interval [CI]: 11.2-19.0) compared with 18.7 months (95% CI: 13.9-23.6) in the low dose group. Grade 3/4 neutropenia occurred in 22/26 high dose patients (84.6%) and 21/31 low dose patients (67.7%). In the high dose group, 30.8% of patients had grade 3/4 esophagitis compared with 19.4% of low dose patients. Only 29.0% of low dose patients received < 4 cycles of chemotherapy in the first 12 weeks after treatment began compared with 46.2% of high dose patients. Concurrent chemoradiotherapy is a tolerable modality for treating stage IIIA/IIIB SCLC with SVCS. Moderate-dose radiotherapy is preferable.
约10%的小细胞肺癌（SCLC）病例会发生上腔静脉综合征（SVCS）。许多患有SVCS的SCLC患者疾病相对局限，需要进行根治性而非姑息性治疗。除化疗外，放疗对于治疗伴有SVCS的SCLC很重要。我们回顾性评估了放疗剂量对57例接受同步放化疗的伴有SVCS的SCLC患者预后的影响。平均生物等效辐射剂量为71.5 Gy。我们给予依托泊苷/顺铂进行序贯和同步化疗。所有患者至少接受了一个周期的同步化疗。所有患者均有部分或完全缓解；87.7%（50/57）的患者在治疗后3至10天内与SVCS相关的症状减轻。放疗剂量不影响2年局部控制率（74.2%对80.8%）。接受高剂量放疗的患者2年总生存率低于接受低剂量放疗的患者（11.6%对33%；P = 0.024）。高剂量组中位生存期为15.0个月（95%置信区间[CI]：11.2 - 19.0），而低剂量组为18.7个月（95% CI：13.9 - 23.6）。22/26例高剂量患者（84.6%）和21/31例低剂量患者（67.7%）发生3/4级中性粒细胞减少。在高剂量组中，30.8%的患者发生3/4级食管炎，而低剂量组为19.4%。治疗开始后的前12周内，只有29.0%的低剂量患者接受的化疗周期少于4个周期，而高剂量患者为46.2%。同步放化疗是治疗伴有SVCS的IIIA/IIIB期SCLC可耐受的方式。中等剂量放疗更佳。
