| Objective:To evaluate the effect of thoracic therapy and the optimal timing of thoracic radiotherapy in the patients with extensive stage small cell lung cancer(SCLC).Methods:93 patients diagnosed with extensive stage small cell lung cancer were enrolled in this study.Forty six patients received chemotherapy and thoracic radiation therapy,and forty seven patients were treated by only chemotherapy.The total dose of thoracic irradiation was 30-60Gy with 1.8Gy-2.0Gy per fraction.The chemotherapy regiments were EP(etoposide 100mg/m~2,continue 3 days and 100mg continue 5 days;cisplatin 75mg/m~2,continue 3 days),EC(etoposide 100mg/m~2,continue 3 days a or 100 mg continue5 days;carboplatin AUC=4-5,1 day),EL(etoposide 100mg/m~2,continue 3 days and 100mg continue 5 days;lobaplatin 30mg/m~2,1 day).Prognostic factors such as gender?age?smoking history?weight loss?the level of NSE?pleural effusion?distant metastasis?the number of distant metastasis?thoracic radiotherapy?the cycles of chemotherapy?the time of thoracic radiotherapy?the response to recent chemotherapy for extensive-stage small cell lung cancer's patients were evaluated by univariate and multivariate analysis.Take Kaplan-Meier and Cox regression analyses to compare overall survival and progress free survival for all patients.Results:1.The ORR of the chemoradiotherapy group and the chemotherapy group were 46.8%(22/47)and 58.7%(27/46),respectively,with no statistical difference(P=0.251);DCR was 59.6%(28/47),respectively and 80.4%(37/46),with statistical difference(P=0.028).2.The median progression-free survival(mPFS)of 93 patients with extensive small cell lung cancer was 8.1 months,and the PFS(%)at 1 year,2 years,and 3 years were29.0%,10.8%,and 5.4%,respectively.The mPFS of the chemotherapy group was 10.8months and 5.8 months,the PFS(%)was 50.0%and 8.5%,and the PFS(%)was 19.6%and 2.1%,respectively.The 3-year PFS(%)were 10.9%and 0%,the difference between the two groups was statistically significant(P<0.001).3.The median survival(MST)of 93 patients with extensive small cell lung cancer was 12.4 months,and the OS(%)at 1 year,2 years,and 3 years were 54.8%,22.6%,and10.8%,respectively.The MST of the radiotherapy and chemotherapy group and the chemotherapy alone group were 18.4 months and 9.1 months,respectively.The 1-year OS(%)was 82.6%and 27.7%,respectively,and the 2-year OS(%)was 43.5%and 2.1%,respectively.%)were 21.7%and 0.0%,respectively,and the difference between the two groups was statistically significant(P<0.001).4.The ORR of the early and late radiotherapy groups were 65%(13/20)and 53.8%(14/26),respectively,with no statistical difference(P=0.446);DCR was 70%(14/20)and80.8%,respectively.(21/26),no statistical difference(P=0.396).5.The mPFS of the early radiotherapy group and the late radiotherapy group were10.8 months and 10.7 months,respectively.The 1-year PFS(%)was 50%and 50%,respectively,and the 2-year PFS(%)was 30%and 11.5%,respectively.The 3-year PFS(%)were 15%and 7.8%,respectively,and the difference was not statistically significant(p=0.181).6.The MST of the early radiotherapy group and the late radiotherapy group were 27months and 15.4 months,respectively.The 1-year OS(%)was 85.0%and 80.8%,respectively,and the 2-year OS(%)was 60.0%and 30.8%,respectively.were 25.0%and19.2%,respectively,and the difference was not statistically significant(p=0.154).7.Univariate survival analysis showed that smoking status,NSE level,distant metastasis status,number of chemotherapy cycles,and treatment mode were all related to OS.8.COX multivariate analysis showed that distant metastasis was an independent adverse factor affecting survival,and chest radiotherapy was an independent factor to improve survival.9.In the first-line treatment progression mode,the local progression of lung lesions in the radiotherapy and chemotherapy group was 11(15.5%)and 16(22.5%),respectively.The distant metastasis occurred in 21(29.6%)and 19 cases,respectively.(26.8%),the incidence of local and distant simultaneous development was 1 case(1.4%)and 3 cases(4.2%),respectively,and the differences between the three groups were not statistically significant.10.In all grades of adverse reactions,all levels of hematologic toxicity occurred in both the chemoradiotherapy group and the chemotherapy group.The incidence of hematologic toxicity of grade I-II in the chemotherapy group was higher than that in the radiotherapy and chemotherapy group(66.0%vs 45.7%,P=0.049).The incidence of grade III-IV hematologic toxicity in the radiotherapy group was higher than that in the chemotherapy group alone(54.3%Vs 34.0%,P=0.029),the difference was statistically significant.The incidence of gastrointestinal toxicity in the radiotherapy and chemotherapy group and the chemotherapy group were 39.1%and 44.7%,respectively,and the difference was not statistically significant.The incidence of I-II gastrointestinal toxicity and III-IV gastrointestinal toxicity in the chemotherapy group was higher than that in the radiotherapy and chemotherapy group(36.2%vs 32.6%,8.5%vs 6.5%),and the difference was not statistically significant.In the radiotherapy and chemotherapy group,the incidence of grade I-II radiation pneumonitis was 21.7%(10/46),and the incidence of grade III-IV radiation pneumonitis was 4.3%(2/47).The incidence of grade I-II radiation esophagitis was 28.3%(13/46),and the incidence of grade III-IV radiation esophagitis was 8.7%(4/46).There were no fatal adverse reactions in either group.Conclusions:1.Chest radiotherapy combined with chemotherapy can improve ORR and DCR in patients with ED stage SCLC,and can prolong PFS and OS,and its 1-year OS(%),2-year OS(%)and 3-year OS(%))have a significant improvement.2.Early radiation therapy in patients with ED stage SCLC can improve the ORR trend of the disease and have a tendency to prolong the OS of patients.The 1-year OS(%),2-year OS(%)and 3-year OS(%)have a higher trend in late radiation therapy.,but no statistical difference.Late radiotherapy patients had an increased DCR trend in early radiotherapy,but there was no statistical difference.3.Early-stage radiotherapy in patients with ED stage SCLC had a prolonged trend in PFS and OS,but there was no statistical difference.4.Univariate analysis showed that smoking history,initial NSE levels,distant metastases,first-line chemotherapy cycles,and whether chest radiotherapy were associated with prognosis in patients with ED SCLC.5.Multivariate analysis showed that distant metastasis was an independent prognostic factor,and chest radiotherapy was an independent prognostic factor for survival.6.There was no significant difference in the progression of the lesions in the lungs between the radiotherapy and chemotherapy groups and the chemotherapy group.Key words:Small cell lung cancer Extensive stage Radiotherapy Prognosis7.Patients with ED stage SCLC receive chest radiotherapy with better safety and higher patient tolerance. |
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