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目的:探讨三维适形(3DCRT)超分割放疗联合EP方案化疗治疗高原地区局限期小细胞肺癌(LSCLC)的疗效和安全性。方法:将40例局限期小细胞肺癌患者随机分为两组,经EP方案诱导化疗2周期后1周~2周内行放疗,放疗中按期进行第3周期化疗。两组患者均采用三维适形放射治疗。试验组采用超分割放疗,放疗总剂量45Gy,分割剂量1.5Gy,2次/天,间隔时间≥6h,5天/周,3周治疗结束。对照组采用常规分割放疗,放疗总剂量50Gy~60Gy,分割剂量为2Gy,1次/天,5天/周,(5~6)周治疗结束。放疗后再行3周期化疗。放化疗结束后疗效评价为完全缓解(CR)的患者接受全脑预防性照射(PCI)。结果:两组患者均耐受并完成治疗,超分割组患者和常规分割组患者放化疗结束时总有效率(CR+PR)为84.2%、61.9%(P>0.05)。超分割组与常规组患者的1、2年生存率分别为78.9%vs 66.7%、47.4%vs 38.1%(P>0.05);Ⅲ°、Ⅳ°血液毒性分别为42.1%vs 33.3%、31.6%vs 19%(P>0.05);Ⅰ°、Ⅱ°放射性肺炎分别为42.1%vs 33.3%、5.3%vs 4.8%(P>0.05);Ⅰ°、Ⅱ°放射性食管炎分别为52.6%vs 42.9%、21.0%vs 14.3%(P>0.05)。结论:三维适形超分割放疗联合EP方案化疗治疗高原地区LSCLC,可缩短总治疗时间,未降低患者疗效及生存率,毒副反应不增加。
Objective: To investigate the efficacy and safety of three-dimensional conformal (3DCRT) hyperfraction radiotherapy combined with EP regimen in the treatment of localized small cell lung cancer (LSCLC) in the plateau. Methods: Forty patients with minimal-stage small cell lung cancer were randomly divided into two groups. The patients were treated with EP regimen for 1 week to 2 weeks after 2 cycles of induction chemotherapy. The third cycle of chemotherapy was performed on schedule. Two groups of patients are using three-dimensional conformal radiotherapy. The experimental group was treated with hyperfraction radiotherapy. The total dose of radiotherapy was 45Gy, the dose was 1.5Gy, twice a day, interval time≥6h, 5 days / week, and the treatment was finished after 3 weeks. The control group received conventional radiotherapy. The total dose of radiotherapy was 50Gy ~ 60Gy, the dose was 2 Gy, once daily, 5 days / week, and (5- 6 weeks) were completed. Radiotherapy followed by 3 cycles of chemotherapy. Patients receiving complete brain prophylaxis (PCI) after completion of chemoradiation with complete remission (CR). Results: The two groups of patients were tolerated and completed the treatment. The total effective rate (CR + PR) at the end of radiotherapy and chemotherapy was 84.2% and 61.9% (P0.05) in the patients in the hyperfractionation group and the conventional group. The 1-year and 2-year survival rates of patients in the hyperfractionation group and conventional group were 78.9% vs 66.7%, 47.4% vs 38.1%, respectively (P> 0.05). The hematological toxicity of Ⅲ ° and Ⅳ ° were 42.1% vs 33.3% and 31.6% vs 19% (P> 0.05). The radioactive esophagitis of Ⅰ ° and Ⅱ ° were 42.1% vs 33.3% and 5.3% vs 4.8% respectively (P> 0.05) , 21.0% vs 14.3% (P> 0.05). Conclusion: Three-dimensional conformal hyperfraction radiotherapy combined with EP regimen in the treatment of LSCLC in the plateau can shorten the total treatment time, reduce the curative effect and survival rate of the patients without increasing the toxic and side effects.