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应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC研究
刘志艳, 姬凯, 刘维帅, 赵路军, 王平
300060 天津,国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津医科大学肿瘤医院放疗科
Clinical efficacy of radical intensity-modulated radiotherapy combined with reduction in dose of prophylactic irradiation in treatment of stage Ⅲ small cell lung cancer
Liu Zhiyan, Ji Kai, Liu Weishuai, Zhao Lujun, Wang Ping
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin 300060, China
Abstract：Objective To evaluate the clinical efficacy and toxicities of radical intensity-modulated radiotherapy (IMRT) combined with reduction in dose of prophylactic irradiation in the treatment of stage Ⅲ small cell lung cancer (SCLC). Methods A retrospective analysis was performed on the clinical data of 40 patients with stage Ⅲ SCLC who were admitted from January 2010 to August 2012. The prescribed dose was 60 Gy in 30 fractions to the primary gross tumor volume and was 54 Gy in 30 fractions to the planning target volume. All patients received induction chemotherapy, 31 patients received adjuvant chemotherapy, and 22 patients received concurrent chemoradiotherapy;the platinum-based chemotherapy combined with etoposide or teniposide was adopted. Prophylactic cranial irradiation (25 Gy in 10 fractions) was administered to 17 patients. The short-term tumor response was evaluated by RECIST 1.0, and radiation-related toxicities were assessed by CTCAE 4.0. Overall survival (OS), local recurrence-free survival (LRFS), and progression-free survival (PFS) were calculated by Kaplan-Meier method. Results The short-term tumor response rate was 98%. The follow-up rate was 100%. Twenty-two patients were followed up for at least 2 years. The 1-and 2-year OS rates were 84% and 48%, respectively;the LRFS rates were 89% and 85%, respectively;the PFS rates were 61% and 41%, respectively. Grade 0—1 radiation-related pneumonia was observed in 65%(26/40) of all patients, grade 2 in 25%(10/40), grade 3 in 5%(2/40), and grade 5 in 5%(2/40). Grade 0—1 radiation-related esophagitis was observed in 53%(21/40) of all patients, grade 2 in 43%(17/40), and grade 3 in 5%(2/40). Conclusions Preliminary results from this study suggested that IMRT combined with reduction in dose of prophylactic irradiation is safe and effective in patients with stage Ⅲ SCLC and is worth further evaluation in a large, prospective, randomized study.
Liu Zhiyan,Ji Kai,Liu Weishuai et al. Clinical efficacy of radical intensity-modulated radiotherapy combined with reduction in dose of prophylactic irradiation in treatment of stage Ⅲ small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(2): 123-126.
[1] Hann CL, Rudin CM. Management of small-cell lung cancer:incremental changes but hope for the future[J]. Oncology,2008,22:1486-1492. [2] Schild SE, Bonner JA, Shanahan TG, et al. Long-term results of a phase Ⅲ trial comparing once-daily radiotherapy with twice-daily radiotherapy in limited-stage small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2004,59:943-951. [3] Komaki R, Swann RS, Ettinger DS, et al. Phase Ⅰ study of thoracic radiation dose escalation with concurrent chemotherapy for patients with limited small-cell lung cancer:Report of Radiation Therapy Oncology Group (RTOG) protocol 97-12[J]. Int J Radiat Oncol Biol Phys,2005,62:342-350. [4] Schild SE, Bonner JA, Hillman S, et al. Results of a phase Ⅰ study of high-dose thoracic radiation therapy with concurrent cisplatin and etoposide in limited-stage small-cell lung cancer (NCCTG 95-20-53)[J]. J Clin Oncol,2007,25:3124-3129. [5] Aridgides PD, Movsas B, Bogart JA. Thoracic radiotherapy for limited stage small cell lung carcinoma[J]. Curr Probl Cancer,2012,36:88-105. [6] Bradley J, Paulus R, Komaki R, et al. A randomized phase Ⅲ comparison of standard-dose (60 Gy) versus high-dose (74 Gy) conformal chemoradiotherapy with or without cetuximab for stage Ⅲ non-small cell lung cancer:results on radiation dose in RTOG 0617[J]. J Clin Oncol,2013,31 Suppl:7501. [7] Withers HR, Peters LJ, Taylor JM. Dose-response relationship for radiation therapy of subclinical disease[J]. Int J Radiat Oncol Biol Phys,1995,31:353-359. [8] Goldstraw P, Crowley J, Chansky K, et al. The IASLC lung cancer staging project:proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours[J]. J Thorac Oncol,2007,2:706-714. [9] Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J]. Eur J Cancer,2009,45:228-247. [10] Komaki R, Paulus R, Ettinger DS, et al. Phase Ⅱ study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer:radiation therapy oncology group protocol 0239[J]. Int J Radiat Oncol Biol Phys,2012,83:e531-e536. [11] Shirvani SM, Komaki R, Heymach JV, et al. Positron emission tomography/computed tomography-guided intensity-modulated radiotherapy for limited-stage small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2012,82:e91-e97. [12] Turrisi AR, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide[J]. N Engl J Med,1999,340:265-271. [13] Turner LM, Howard JA, Dehghanpour P, et al. Exploring the feasibility of dose escalation positron emission tomography-positive disease with intensity-modulated radiation therapy and the effects on normal tissue structures for thoracic malignancies[J]. Med Dosim,2011,36:383-388. [14] Liu HH, Wang X, Dong L, et al. Feasibility of sparing lung and other thoracic structures with intensity-modulated radiotherapy for non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2004,58:1268-1279. [15] Murshed H, Liu HH, Liao Z, et al. Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2004,58:1258-1267. [16] Yom SS, Liao Z, Liu HH, et al. Initial evaluation of treatment-related pneumonitis in advanced-stage non-small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy[J]. Int J Radiat Oncol Biol Phys,2007,68:94-102.
2014, Vol. 23 
