Patterns Of Local-regional Recurrence For Limited-disease Small Cell Lung Cancer After Intensity-modulated Radiotherapy(IMRT)Plus Chemotherapy The Utilization Of Volumetric Modulated Arc Therapy(VMAT)for Limited-Disease Small Cell Lung Cancer

Purpose:To investigate localized regional recurrence after chemotherapy and chest radiotherapy in limited staged small cell lung cancer(LS-SCLC),and explore the relationship between recurrence location and radiotherapy and chemotherapy and its influencing factors.Methods:From 2006 to 2014,pathological LS-SCLC treated in CAMS,125 patients had local recurrence,Kaplan-Meier statistical method was used to analyze the survival rate and PFS of each recurrence site.Log-rank was used to compare the survival rate of each group.Univariate analysis includes Chi-square and T-test for the factors for the recurrence site.Multivariate analysis using logistic regressionResults:The 1-,2-and 5-year overall survival rates were 92.0%,46.4%and 14.7%,respectively.The median progression time was 12.96 months,The median survival time after progression was 11.5 months,and the 1-,2-,and 5-year overall survival rates were 45.0%,23.0%,and 10.0%,respectively.The recurrence sites include intrapulmonary recurrence(67 patients),regional lymph nodes(21 patients),simultaneous intrapulmonary and regional lymph nodes(28 patients),and contralateral or supraclavicular lymph nodes(9 patients).The median survival time were 23.96 months,24.76 months,23.23 months,and 18.66 months,and the 2-year survival rates were 49%,52%,46%,and 11%,respectively(P=0.000,0.004,0.008).In 6 patients(4.0%),5 patients were located in the supraclavicular region,and 1 patient(0.8%)in the fieldConclusions:For LS-SCLC undergoing IMRT and chemotherapy,the local failure location is mainly located in the pulmonary,and further treatment of the split dose and targets requires further clinical exploration.Objective:To investigate the outcome and toxicity in the treatment of Volumetric Modulated Arc Therapy(VMAT)for LD-SCLC.Methods:Retrospectively analysis of patients treated with VMAT and chemotherapy for LD-SCLC in CAMS.Kaplan-Meier statistical method was used to analyze the survival rate and the toxicities were evaluated according to the CTCAE 4.0 criteria.Log-rank was used to compare the survival rate of each group.Multivariate analysis using Cox regressionResults:68 patients had localized lesions with PR or CR,and 26 patients had SD.The effective rate was 94.9%.The 1-,2-year overall survival rates were 82.8%and 59.5%,respectively.The median survival time was 26.4 months.The incidence of≥grade 2 radiation pneumonitis was 16.1%,1 patient died of radiation pneumonitis,The incidence of≥2 grade radiation esophagitis and hematological toxicity were 28.3%and 31.3%,respectively.No grade 4-5 radioactive esophagitis or hematological toxicity occurred.Multivariate analysis shows that prophylactic brain irradiation(PCI)may be an independent factor affecting prognosis.Conclusion For LD-SCLC undergoing volumetric modulated arc therapy,there is great clinical efficiency and toxicity.VMAT should be widely used in clinical practice.The specific benefit stratification patients need further clinical trials.