Turgeon G A, Souhami L, Kopek N, Hirsh V, Ofiara L, Faria S L
Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
Department of Oncology, Division of Medical Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
Cancer Radiother. 2017 Apr;21(2):89-98. doi: 10.1016/j.canrad.2016.09.015. Epub 2017 Mar 18.
Many Canadian institutions treat limited-disease small cell lung cancer with 40Gy in 15 fractions delivered once-a-day in 3weeks concomitantly with chemotherapy. This regimen is convenient and seems to be effective. Here, we report and compare with a literature review the outcomes of patients with limited-stage small cell lung cancer treated in our institution with this hypofractionated regimen.
From January 2004 to December 2012, patients with limited-stage small cell lung cancer treated curatively with platinum-based chemotherapy and concurrent thoracic radiotherapy at a dose of 40Gy in 16 fractions once-a-day were eligible for this review.
Sixty-eight patients fit the analysis criteria, including ten patients with small pleural effusion. The median age was 66years old. After a median follow-up of 77months for those alive, the median survival was 28months. At 3 and 5years respectively, the locoregional control rates were 67 and 64%, while the overall survival rates were 40 and 35%. Prophylaxis cranial irradiation was delivered to 68% of the patients. Grade 2 and 3 acute esophagitis occurred in respectively 49 and 9% of the patients. There was no grade 4 radiation-induced toxicity. All patients, except for one, completed their thoracic irradiation course without interruption.
Once-a-day hypofractionated radiation with concurrent chemotherapy followed by prophylactic cranial irradiation is a practical regimen. Based on our experience and the published literature, it appears to be similarly effective as regimens using twice-daily fractionation in 3weeks, or once-daily in 6 to 7weeks with higher radiotherapy doses. Further prospective comparisons of hypofractionation with the current recommendations are needed.
许多加拿大机构采用在3周内每天一次给予15次分割、总剂量40Gy的放疗方案来治疗局限性小细胞肺癌，并同时进行化疗。该方案便捷且似乎有效。在此，我们报告在本机构采用这种超分割方案治疗的局限期小细胞肺癌患者的治疗结果，并与文献综述进行比较。
2004年1月至2012年12月期间，接受以铂类为基础的化疗及同步胸部放疗（每天一次，16次分割，总剂量40Gy）进行根治性治疗的局限期小细胞肺癌患者符合本综述的纳入标准。
68例患者符合分析标准，其中包括10例伴有少量胸腔积液的患者。中位年龄为66岁。对存活患者进行中位77个月的随访后，中位生存期为28个月。3年和5年时，局部区域控制率分别为67%和64%，总生存率分别为40%和35%。68%的患者接受了预防性脑照射。2级和3级急性食管炎分别发生在49%和9%的患者中。无4级放射性毒性反应。除1例患者外，所有患者均未中断完成胸部放疗疗程。
每天一次的超分割放疗联合化疗，随后进行预防性脑照射是一种实用的方案。基于我们的经验和已发表的文献，该方案似乎与3周内每天两次分割或6至7周内每天一次分割且放疗剂量更高的方案具有相似的疗效。需要进一步对超分割方案与当前推荐方案进行前瞻性比较。
