Ohara Sayaka, Kanda Shintaro, Okuma Hitomi, Goto Yasushi, Horinouchi Hidehito, Fujiwara Yutaka, Nokihara Hiroshi, Ito Yoshinori, Yamamoto Noboru, Usui Kazuhiro, Homma Sakae, Ohe Yuichiro
Department of Thoracic Oncology, National Cancer Center Hospital.
Department of Respiratory Medicine, Toho University Graduate School of Medicine.
Jpn J Clin Oncol. 2018 Jan 1;48(1):82-88. doi: 10.1093/jjco/hyx153.
The standard treatment for limited-disease small-cell lung cancer (LD-SCLC) is a combination of chemotherapy and concurrent thoracic radiotherapy. In selected cases, sequential radiotherapy is preferred because of the need for a large irradiation field, patient age, comorbidities or performance status. Nevertheless, the efficacy of sequential chemoradiotherapy in patients in whom concurrent chemoradiotherapy is contraindicated is not well known.
We retrospectively analyzed 286 patients with LD-SCLC at two institutions in Japan between 2000 and 2014. We compared the clinical characteristics and treatment outcomes of patients undergoing sequential radiotherapy with those undergoing concurrent radiotherapy.
One hundred and seventy-five patients received concurrent chemoradiotherapy, 33 received sequential chemoradiotherapy and 46 received chemotherapy only. The median patient age was 64 years (range, 18-82 years) for the concurrent group and 71 years (49-82 years) for the sequential group. Conventional radiotherapy was selected more frequently than accelerated hyperfractionated radiotherapy (27 patients [82%] with conventional radiotherapy, and six patients [18%] with hyperfractionated radiotherapy). The major reasons for the selection of sequential radiotherapy were advanced age (12 patients) and a large irradiation field (11 patients). The median overall survival time was 41.1 months for the sequential group and 38.1 months for the concurrent group. The 5-year survival rates were 36.0% for the sequential group and 41.6% for the concurrent group.
In clinical situation, since the treatment outcomes for patients with sequential radiotherapy were comparable to those receiving concurrent radiotherapy, sequential chemoradiotherapy can be a choice for the treatment of patients who are not candidates for concurrent chemoradiotherapy.
局限期小细胞肺癌（LD-SCLC）的标准治疗是化疗与同期胸部放疗联合。在某些特定情况下，序贯放疗更受青睐，原因在于需要大照射野、患者年龄、合并症或体能状态等因素。然而，同期放化疗禁忌的患者接受序贯放化疗的疗效尚不明确。
我们回顾性分析了2000年至2014年间日本两家机构的286例LD-SCLC患者。我们比较了接受序贯放疗的患者与接受同期放疗的患者的临床特征和治疗结果。
175例患者接受同期放化疗，33例接受序贯放化疗，46例仅接受化疗。同期组患者的中位年龄为64岁（范围18 - 82岁），序贯组为71岁（49 - 82岁）。常规放疗的选择频率高于加速超分割放疗（常规放疗27例[82%]，超分割放疗6例[18%]）。选择序贯放疗的主要原因是高龄（12例患者）和大照射野（11例患者）。序贯组的中位总生存时间为41.1个月，同期组为38.1个月。序贯组的5年生存率为36.0%，同期组为41.6%。
在临床情况下，由于序贯放疗患者的治疗结果与同期放疗患者相当序贯放化疗可作为不适合同期放化疗患者的一种治疗选择。
