Kumar P
Department of Radiation Oncology, University of Tennessee, and the Veteran's Administration Medical Center, Memphis 38104, USA.
Chest. 1997 Oct;112(4 Suppl):259S-265S. doi: 10.1378/chest.112.4_supplement.259s.
The role of thoracic radiation therapy in the management of limited-stage small cell lung cancer (SCLC) is reviewed. Although chest irradiation has been used to treat SCLC for over four decades, its standard role in the management of limited-stage disease was established only during the last decade. Multiple prospective randomized trials have shown that the addition of thoracic radiation therapy to chemotherapy usually halves local failure rates, from >60% with chemotherapy alone to about 30% with chemoradiation therapy. Additionally, survival at 3 years is also improved by 50%, from 10% with chemotherapy alone to about 15% with chemoradiation therapy. However, issues relating to the timing, volume (ie, prechemotherapy vs postchemotherapy), and the dose fractionation scheme of thoracic radiation therapy in the treatment of limited-stage SCLC still remain unresolved. Recent review of the literature indicates the most optimal timing of thoracic radiation therapy appears to be concurrent with chemotherapy vs either a sequential or an alternating approach. Studies are currently under way evaluating the optimal volume and dose fractionation scheme to use in the delivery of thoracic radiation therapy. In summary, thoracic radiation therapy significantly improves both local chest control and survival in the treatment of limited-stage SCLC.
本文综述了胸部放射治疗在局限期小细胞肺癌（SCLC）治疗中的作用。尽管胸部照射用于治疗SCLC已有四十多年，但它在局限期疾病治疗中的标准作用直到过去十年才得以确立。多项前瞻性随机试验表明，在化疗基础上加用胸部放射治疗通常可使局部失败率减半，从单纯化疗时的>60%降至放化疗时的约30%。此外，3年生存率也提高了50%，从单纯化疗时的10%提高至放化疗时的约15%。然而，在局限期SCLC治疗中，胸部放射治疗的时机、照射范围（即化疗前还是化疗后）以及剂量分割方案等问题仍未得到解决。最近的文献综述表明，胸部放射治疗的最佳时机似乎是与化疗同步进行，而非序贯或交替进行。目前正在进行研究，以评估胸部放射治疗的最佳照射范围和剂量分割方案。总之，胸部放射治疗在局限期SCLC治疗中可显著提高局部胸部控制率和生存率。
