老年广泛期小细胞肺癌放疗价值研究

目的 探讨胸部放疗(TRT)对老年广泛期小细胞肺癌(ES-SCLC)患者预后的影响。方法 回顾分析天津医科大学肿瘤医院2010-2016年收治的83例≥65岁转移性ES-SCLC患者,所有入组患者均接受依托泊苷联合顺铂或卡铂标准方案化疗。经PSM倾向评分匹配有无TRT各入组35例。男56例、女14例,年龄65~85岁(中位数69岁),化疗1~11个周期(中位数4个周期),胸部照射剂量30~60 Gy (中位数50 Gy)。观察终点为总生存(OS)、无进展生存(PFS)、局部无复发生存(LRFS)。采用Kaplan-Meier方法计算生存率,Logrank比较组间差异,Cox回归模型多因素预后分析。结果 全组患者1年OS、PFS、LRFS率分别为40%、16%、21%;有无TRT患者的1年OS率分别为52%和29%(P=0.005),1年PFS率分别为30%和3%(P<0.001),1年LRFS率分别为38%和6%(P<0.001)。接受TRT并未增加患者不良反应的发生率(P=0.690)。结论 老年ES-SCLC患者加用TRT能够明显提高胸部肿瘤控制率,延长患者生存期,值得进一步进行大样本前瞻性研究证实。

Therapeutic value of thoracic radiotherapy in elderly patients with extensive-stage small cell lung cancer

Objective To evaluate the effect of thoracic radiotherapy (TRT) on the prognosis of elderly patients with extensive-stage small cell lung cancer (ES-SCLC). Methods Clinical data of 83 patients aged≥65 years diagnosed with metastatic ES-SCLC admitted to our hospital from 2010 to 2016 were retrospectively analyzed. All enrolled patients received etoposide plus cisplatin or carboplatin as the standard regimen for chemotherapy. After the propensity score matching (PSM), 70 cases were either assigned into the TRT (n=35) or non-TRT groups (n=35). Among them, 56 patients were male and 14 female. The median age was 69 years (range:65-85 years). The median chemotherapy cycle was 4 cycles (range:1-11 cycles). The median chest irradiation dose was 50 Gy (range:30-60 Gy). Overall survival (OS), progression-free survival (PFS) and local recurrence-free survival (LRFS) were regarded as end-point of observation. The survival rate was calculated by using Kaplan-Meier method and statistically compared between two groups by using Log-rank test. Multivariate prognostic analysis was performed using Cox regression model. Results For all patients, the 1-year OS, PFS and LRFS rates were 40%, 16% and 21%, respectively. Patients undergoing TRT obtained better survival outcomes than their counterparts without TRT:the 1-year OS, PFS and LRFS were 52% vs.29%(P=0.005), 30% vs.3%(P<0.001), 38% vs. 6%(P<0.001), respectively. Furthermore, TRT did not increase the incidence of adverse reactions in elderly patients (P=0.690). Conclusion The addition of TRT for elder ES-SCLC patients can significantly improve the rate of chest tumor control and prolong the survival time, which is worthy of further validation by prospective studies with large sample size.