【摘要】 目的:通过复习局限期小细胞肺癌(SCLC)放射治疗的文献,探讨局限期SCLC最佳放射治疗策略。方法:应用计算机检索PubMed和CHKD数据库有关SCLC放射治疗的70篇研究文章,纳入分析39篇,检索词为小细胞肺癌、局限期、放射治疗和预防性脑照射。结果:试验表明放射治疗优于手术治疗,中位总生存期手术组为6个月,放疗组为10个月,差异有统计学意义;Meta分析显示,联合化疗+放疗较单纯联合化疗方法改善了生存期,单纯联合化疗组患者3年生存率为8.9%,联合化疗+放疗组3年生存率为14.3%,P=0.001。预防性脑照射(PCI)的作用已肯定。但是,胸部照射(thoracic radiation therapy,TRT)的剂量、时机和靶体积等问题未完全解决。结论:局限期SCLC的治疗策略为化疗和同步TRT以及预防性脑照射(PCI)。胸部照射应该在化疗早期(化疗第1或2个周期)进行,不赞同根据化疗前肿瘤体积来确定照射靶区。PCI应尽可能在化疗完成后就开始。更多还原

【Abstract】 OBJECTIVE:To review the papers about radiotherapy for limited small cell lung cancer(L-SCLC) during the past years and to explore optimal radiation therapy schedules in small cell lung cancer.METHODS:Small cell lung cancer,limited stage,radiotherapy or radiation therapy,and prophylactic cranial irradiation(PCI) were used as the key words,70 research papers which referred to radiotherapy for limited small cell lung cancer were collected by retrieval system PubMed and data system CHKD,and 39 articles were selected into analysis.RESULTS:An MRC(Medical Research Council) trial shows that the overall survival is better for patients in the radiation therapyalone arm than for patients in the surgery arm(10 month vs 6 month).Meta-analyses shows that the addition of thoracic radiation therapy(TRT) to systemic chemotherapy results in an increase in the 3-year survival rate from 8.9% to 14.3%(P=0.001).The role of prophylactic cranial irradiation(PCI) is currently recommended to patients with limited SCLC.However,thoracic radiation therapy(TRT) dose,time,and target volume are not completely settled.CONCLUSIONS:At present,for patients with limited SCLC,that etoposide and cisplatin and concurrent thoracic radiation therapy(TRT),are usually given during the first or second cycle is the standard.Increasing the size of RT field to prechemotherapy volume is not recommended.Prophylactic cranial irradiation(PCI) is currently recommended and should probably start as soon after the completion of chemotherapy as possible.更多还原