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Objective:To investigate the changes of the expression levels of serum proliferating cell nuclear antigen (PCNA), tumor-specific growth factor (TSGF), soluble E-cadherin (SE-CAD) and the relationship with clinical prognosis of advanced non-small cell lung cancer (NSCLC) patients treated with intensity-modulated radiotherapy combined with chemotherapy.Methods:Eighty-four patients (29 cases of Ⅲ A, 30 Ⅲ B and 25 Ⅳ) with advanced NSCLC treated in our hospital from January 2016 to January 2018 were selected, and all patients were given with intensity-modulated radiotherapy combined with chemotherapy. The expression levels of serum PCNA, TSGF, and SE-CAD were compared among different TNM stages and before and after treatment. The serum PCNA, TSGF, SE-CAD levels were compared among patients with different clinical efficacy. The relationship between serum PCNA, TSGF and SE-CAD levels and clinical efficacy was assessed by Logistic regression analysis. The survival analysis was performed with Kaplan- Meier method. Results:The expression levels of serum PCNA, TSGF and SE-CAD before treatment in stage Ⅳ patients were significantly higher than those in stage Ⅲ B and Ⅲ A patients (584.11±60.25 pg/ml vs. 531.06±51.37 pg/ml and 477.54±46.49 pg/ml, 96.13±7.54 U/ml vs. 8.52±5.91 U/ml and 82.41±5.0 U/ml, 3.02±0.26 ng/ml vs. 2.87±0.22 ng/ml and 2.71±0.15 ng/ml, all P<0.05), and the serum levels of three cytokines in Ⅲ B stage patients were significantly higher than those in their Ⅲ A stage counterparts (all P<0.05). After treatment, the serum levels of PCNA, TSGF and SE-CAD were significantly lower than those before treatment (396.11±50.23 pg/ml vs. 528.37±75.09 pg/ml, 74.81±4.72 U/ml vs. 88.68±6.13 U/ml, 1.92±0.24 ng/ml vs.2.86±0.31 ng/ml, all P<0.05). At 18 months after treatment, the serum levels of PCNA, TSGF and SE-CAD in surviving patients were significantly lower than those of dead patients (332.51±54.32 pg/ml vs. 444.92±60.07 pg/ml, 70.59±6.20 U/ml vs. 78.05±8.44 U/ml, 1.71±0.24 ng/ml vs. 2.08±0.27 ng/ml, all P<0.05). The serum levels of PCNA, TSGF and SE-CAD were significantly associated with clinical prognosis (all P<0.05). Among 84 NSCLC patients, the objective response rate after treatment was 29%(24/84). The survival curves in patients with high expression levels of serum PCNA, TSGF and SE-CAD were significantly lower than those in the low-expression group (all P<0.05). Conclusion:Serum PCNA, TSGF and SE-CAD are highly expressed in patients with advanced NSCLC, which are closely correlated with clinical staging and prognosis and contribute to predicting survival status.
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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.
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Objective To investigate the effects of different chemoradiotherapy ( CRT) schemes on the prognosis of extensive?stage small?cell lung cancer ( SCLC ) . Methods A retrospective analysis was performed in 322 patients with extensive?stage SCLC who were admitted to our hospital from 2011 to 2015.All patients received standard EP/CE ( etoposide+cisplatin/carboplatin) chemotherapy. According to RECIST criteria, the efficacy of chemotherapy was divided into complete response, partial response, stable disease, and progressive disease ( PD). A total of 232 patients without PD after chemotherapy were enrolled as subjects and divided into radiotherapy group (n=187) and non?radiotherapy group (n=45).The patients undergoing radiotherapy were further divided into early radiotherapy group ( before 3 cycles of chemotherapy, n=65) and late radiotherapy group (after 3 cycles of chemotherapy, n=122),or concurrent CRT group ( n=45 ) and sequential CRT group ( n=142 ) . The survival rates were analyzed using the Kaplan?Meier method. Between?group comparison was made by log?rank test. The Cox regression model was used for multivariate prognostic analysis. Results In all the patients, the median overall survival ( OS ) , progression?free survival (PFS),and local recurrence?free survival (LRFS) time was 13?2,8?7,and 14?6 months, respectively. The non?radiotherapy group had significantly shorter median OS, PFS, and LRFS time than the radiotherapy group ( 8?7 vs. 15?0 months, P=0?00;5?6 vs. 9?8 months, P=0?00;5?9 vs. 19?2 months, P=0?00).There were no significant differences in median OS, PFS, or LRFS time between the early radiotherapy group and the late radiotherapy group ( 15?4 vs. 14?6 months, P=0?720;8?0 vs. 10?8 months, P=0?426;19?2 vs. 18?1 months, P=0?981) . The concurrent CRT group had significantly longer median OS time than the sequential CRT group (19?4 vs. 13?8 months, P=0?036),while there were no significant differences in median PFS or LRFS time between the two groups ( 10?8 vs. 9?8 months, P=0?656;19?8 vs. 17?8 months, P= 0?768 ) . Generally, patients undergoing radiotherapy had increased incidence rates of adverse reactions than those without radiotherapy (P=0?038).However, the incidence rates of grade ≥3 adverse reactions were similar between the two groups ( P=0?126) . Conclusions In the treatment of extensive?stage SCLC, thoracic radiotherapy improves the treatment outcomes without increasing the incidence rates of severe adverse reactions. When to receive radiotherapy has nothing to do with the prognosis. Concurrent CRT may further improve the treatment outcomes, which still needs further studies.
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Objective To explore the incidence and related predictive factors for acute symptomatic esophagitis in patients with locally advanced non?small cell lung cancer ( NSCLC ) treated with intensity?modulated radiation therapy ( IMRT) . Methods Data were collected retrospectively from 256 patients with inoperable or unresectable stage Ⅲ NSCLC treated in our hospital between January 2007 and December 2011. The radiotherapy target volume included primary lung cancer and lymphatic drainage area involved,with a median dose of 60 Gy in 30 fractions (50-70 Gy).Of all the patients,109 patients (42.6%) received concurrent chemotherapy. Grade ≥2 acute esophagitis ( AE ) ( symptomatic esophagitis ) which occurred during radiotherapy and within 3 months after completion of radiotherapy served as the outcome event. National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0( NCI?CTCAE3.0) was used to evaluate the grade of AE. The logistic regression model was used to analyze the predictive factors. Results A total of 174 patients ( 68%) had treatment?related grade ≥2 AE;154 patients ( 60. 2%) had grade 2 AE and 20 patients (7.8%) had grade 3 AE.The median dose when grade≥2 AE occurred was 30 Gy (11?68 Gy).For grade≥2 AE,multivariate analysis showed that esophageal V5?V60,mean dose,and age were independent predictive factors (P=0.021,0,0.010).For grade ≥3 AE,multivariate analysis showed that esophageal V50?V60 ,concurrent chemotherapy,and body mass index ( BMI) were independent predictive factors ( P= 0.010,0.003,0.019 ) . Old age and higher BMI were the protective factors for grade≥2 and ≥3 AE, respectively. Conclusions For patients with locally advanced NSCLC treated with IMRT, esophageal V50—V60 and concurrent chemotherapy are predictive factors for grade ≥3 AE,and esophageal V50 has a high predictive value for both grade ≥2 and ≥3 AE.
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Objective To investigate the incidence of radiation?induced lung injury ( RILI ) in patients with locally advanced non?small cell lung cancer ( LA?NSCLC ) after involved?field intensity?modulated radiotherapy ( IMRT) and concurrent chemotherapy, and to figure out the predictive factors for RILI. Methods Two hundred and fifty?six patients with stage Ⅲ NSCLC who were treated without surgery in our hospital from January 2007 to December 2011 were enrolled as subjects. All patients received involved?field IMRT with a median dose of 60 Gy ( 50?70 Gy) in 30 fractions. In all patients, 109 patients (42.6%) received concurrent chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events Version 3. 0 was used to evaluate the RILI grade. The incidence of grade ≥2 RILI ( symptomatic RILI, SRILI ) within 6 months after radiotherapy served as the end point. The predictive factors for RILI were analyzed using logistic regression model. Results In all patients, 215 ( 84%) were male, and 41(16%) were female. The mean age at diagnosis was 59.2 years. Forty?three (16.7%) patients had grade ≥2 RILI. The mean duration between the incidence of RILI and the beginning of radiotherapy was 64 days ( 20?169 days) . Univariate analysis showed that smoking, peripheral or central tumor location, mean lung dose ( MLD) for both lungs, and V5?V20 for both lungs were suspected to be associated with the development of SRILI (P=0.108,0.106,0.030,0.049). Multivariate analysis showed the MLD and V5?V20 for both lungs were independent predictive factors for SRILI P=(0.048). Conclusions For patients with LA?NSCLC treated with involved?field IMRT, the MLD and the volume of low?dose region in dose volume histogram for both lungs are significantly correlated with the incidence of SRILI.
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Objective To investigate independent prognostic factors for overall survival (OS) in extensive disease small cell lung cancer (EDSCLC). Methods Between January 2003 and December 2006, 154 patients diagnosed with extensive stage small cell lung cancer were enrolled in this study.Prognostic factors such as gender, age, performance status, smoking history, weight loss, distant metastasis, the number of matastasis, brain metastasis, the cycle of chemotherapy and thoracic radiation therapy (TRT) for EDSCLC patients were evaluated by univariate and multivariate analysis. Results The median following-up time was 40. 5 months. The rate of follow-up was 92. 2%. The MST and overall survival rates at 3-year in smoking group and no-smoking group were 13 months, 11.8% and 17 months,22. 8%,respectively (χ2=3.40,P =0. 064);in ChT/TRT group and ChT group, they were 17. 2 months, 17.9%and 9.3 months,13.9%, respectively(χ2=10.47,P=0.001);and in the cycle of chemotherapy ≥4 group and ＜ 4 group, they were 16 months, 20. 1% and 9.3 months, 2. 9%, respectively (χ2=17.79,P=0. 000). By multivariate analysis, smoking history was a statistically significant unfavorable factor for OS in EDSCLC patients (versus no-smoking, hazard ratio (HR)=1.462, χ2=4.40, P=0.036). In addition, ≥4 cycles of chemotherapy and TRT were favorable prognostic factors ( ≥4 cycles vs ＜4 cycles, HR =0. 420,χ2 = 17. 17, P = 0. 000; ChT/TRT vs ChT, HR = 0. 634, χ2 = 6. 20, P = 0. 013). Conclusions Smoking is a independent unfavorable prognostic factor and ≥ 4 cycles of chemotherapy And TRT are independent favorable prognostic factors for OS in EDSCLC.
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Objective To evaluate the toxicity and efficacy of induction chemotherapy(ICT)followed by three-dimensional conformal radiotherapy(3 DCRT)plus concurrent weekly paclitaxel for inoperable non-small cell lung cancer(NSCLC). Methods Patients with stage Ⅲ NSCLC in favorable conditions were treated with 2 to 4 cycles of carboplatin(AUC=5-6,d1)combined with paclitaxel(175 mg/m2,d1),then followed by weekly paclitaxel(40 mg/m2)and concurrent 3DCRT within 3-4 weeks.The prescription dose of radiotherapy was given as high as possible while total lung V20≤31% and total dose of the spinal cord ≤50 Gy. Results ICT was well tolerated.During the concurrent chemoradiotherapy,the treatment of 4 patients was ended ahead of the schedule because of severe pulmonary and cardiac toxicities:the treatment of 2 patients was delayed for 7 and 12 days because of fatigue.Leucopenia(33/56)was in grade 1-2 except 1 patient in grade 3.Lymphocytopenia was severe(54/56,42 in grade 3).Three patients developed grade 3 acute radiation-induced esophagitis.and 3 developed grade 3-4 radiation-induced pneumonitis.There was one patients each who developed grade 2,3,and 4 late esophagealdamage,respectively.Nine developed grade 2 pulmonary fibrosis.The overall response rate was 69.7%.The 1-year overall survival rate was 72.3%.The 1-year local progression-free survival rate was 62.7%. Conclusions The schedule of ICT followed by weekly paclitaxel and concurrent 3DCRT can be well tolerated by most of the favorable patients with stageⅢ NSCLC.and the toxicity is tolerable. Results of this study are encouraging, though long-term results should be followed up.
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Objective To investigate the efficacy and the side-effects of concurrent chemoradiotherapy combined with consolidation or induction chemotherapy for locally advanced non-small cell lung cancer(NSCLC).Methods64 patients with stage ⅢA and ⅢB NSCLC were divided randomly into the CCT group(concurrent chemoradiotherapy followed by consolidation chemotherapy) and the ICT group(induction chemotherapy followed by concurrent chemoradiotherapy).All patients were deliverd to thoracic planning target with total dose of 54~66Gy(median dose 60Gy)in 6~7 weeks.CCT group started to irradiate by conformal radiotherapy technique on day 1,and ICT started on day 43 with single fraction dose 200 cGy and 5 fractions every week.ResultsThe response rate in CCT and ICT group was 60.0% and 58.8% respectively(P=0.924),with no statistic significance between the CCT and ICT group.The side-effects were mainly granulo-cytopernia,radiation espohagitis and radiation pneumonitis.ConclusionConcurrent chemoradiotherapy combined with consolidation or induction chemotherapy for locally advanced NSCLC is well tolerated.The sequence of adjuvant chemothreapy to concurrent chemoradiotherapy produced no significant difference for NSCLC in recent response.
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Objective To evaluate the treatment effects of chemotherapy comparing with chemotherapy and radiotherapy in the limited-stage small cell lung cancer (SCLC). Methods 234 patients were cyto-pathologically diagnosed and staged as limited small cell lung cancer. The patients were treated with combined chemotherapy and radiotherapy,in which 22 cases were treated by alone chemotherapy (C),39 patients by chemotherapy plus radiotherapy(C+R),and 173 cases by combined chemotherapy and radiotherapy + chemotherapy (C+R+C). The chemotherapy regimen included CE (or PE),CAP or CAV for 4~6 cycles. Irradiation treatment covering the primary tumor,the ipsilateral hilar nodes and mediastinum was delivered once daily with 6 megavoltage X-ray beam to a median irradiation does of 56 Gy being given in 5~6 weeks. Results The 1-,2-,3-,and 5-year overall survival rates were 76.5%,38.2%,25.3%,15.6% respectively,and the median survival time (MST) was 19 months. There was a significantly difference on the survival rate between C+R+C group and C+R group or C group (P
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0.05). Conclusions For patients with locally advanced non-small cell lung cancer, concurrent conformal radiotherapy and chemotherapy followed by consolidation chemotherapy can improve the progression-free survival, but have few effects on overall survival and toxicity. Multicenter clinical trial with more patients should be carried out to confirm the benefit from the additional consolidation chemotherapy.
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Objective To evaluate the effect and tolerance of late-course three dimensional conformal radiotherapy(LC3DCRT) combined with concurrent chemotherapy for stage Ⅲ non-small cell lung cancer(NSCLC).Methods From May 2000 to May 2003,48 such patients were entered into this study.The patient's characteristics were: 38 male and 10 female,with median age of 62 years(range 40 to 74);Karnovsky performance score ≥70;stage ⅢA 16 and ⅢB 32,squamous cell carcinoma 38 and adenocarcinoma 10.The treatment regimen consisted of conventional radiotherapy first(40Gy/20f/4W),followed by 3DCRT(24-30Gy/4-5f/2W) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,ipsilateral hilum and mediastinal lymph drainage region.LC3DCRT focused on the primary lesion only,with the 80%-90% isodose curve covering the planning target volume(PTV) and the target dose was prescribed to PTV.Supraclavicular metastatic lymph node was treated by mixed 6MV X-ray and electron beam to a total dose of 65-70Gy.Chemotherapy treatment regimen consisted of isophosfomide(25mg/m~2,d1、8,iv) and cisplatin(30mg/d,d1-3,iv) in the 1st and 5th week.Results Before the end of the second month after treatment,the complete response(CR)and partial response(PR) rate was 16.7% and 75.0%,respectively,with a CR+PR rate of 91.7%.The 1-,2-and 3-year local control and overall survival rates as monitored by the Kaplan-Meier method was 87.5%,50.0%,35.7% and 87.5%,46.7%,28.6%,respectively.All patients completed the planned treatment without interruption.Hematological toxicity and radiation-induced pneumonitis as shown by the WHO staging system were the most common acute toxicities but they were tolerable,with 8.3% of grade 3 leukopenia and 4.2% of grade 3 radiation-induced pneumonitis.The severity of the other acute toxicities such as nausea,fever,hemoglobin decrease,and radiation-induced esophagitis were mainly grade 1 or grade 2.Conclusions Late course three dimensional radiotherapy combined with concurrent chemotherapy shows a promising results with tolerable acute toxicities.Long-term survival and late toxicities need further observation.
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Objective To evaluate the efficacy of concurrent systemic routine dose of paclitaxel/ cisplatin combined with conventional thoracie irradiation in locally advanced non-small cell lung cancer(NSCLC).Methods Forty-two unresectable stage ⅢA and ⅢB NSCLC patients were entered into this study.All patients received conventional thoracic irradiation to a total dose of 60Gy within 6 weeks,with concurrent paclitaxel 135mg/m~2,d1,and cisplatin 75mg/m~2 in the first and fourth week of radiotherapy.Results The complete response(CR) and partial response(PR) was 2/42,and 30/42 patients,with an overall response rate of 76.2% and a median survival time of 18 months.The 1-,2-,and 3-year survival rate was 64.3%,30.2%,12.0%,respectively.The 1-,2-,and 3-year progression-free survival rates was 48.1%,21.4%,5.7%,with a median progression-free survival of 12 months.Fourteen patients failed only locoregionally,10 in distant metastastasis only and 5 in both.The locoregional/distant failure rate was higher in stageⅢB than in stage ⅢA(P
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Objective Prospective comparison was done on concurrent chemo-radiotherapy and se- quential chemo-radiotherapy for unresectable stageⅢnon-small cell lung cancer(NSCLC) and to evaluate three different regimens of concurrent chemo-radiotherapy.Methods Ninety-six such patients were ran- domized into four groups:1.sequential chemo-radiotherapy group received two cycles of induction chemother- apy with 40 mg/m~2 of cisplatin on D 1-3,29-31 and 100 mg/m~2 of etoposide on D 1-3,29-31 before conven- tional radiotherapy,2.concurrent chemo-radiotherapy group 1 received 100 mg/m~2 etoposide on D 1-3 and DDP 40 mg/m~2 on D 1-3,D 29-31,iv.drip,3.concurrent chemo-radiotherapy group 2 received concurrent chemotherapy with 40 mg/m~2 of paclitaxel every Monday during conventional radiotherapy,4.concurrent chemo-radiotherapy group 3 received concurrent chemotherapy with 40 mg/m~2 of paclitaxel every Monday during three-dimensional conformal radiotherapy.All patients were irradiated with 2.0 Gy/fraction,5 frac- tions/week,to a total dose of 60-64 Gy.They all received two cycles of consolidation themotherapy with 40 mg/m~2 of cisplatin on D 1-3 and 100 mg/m~2 of etoposide on D 1-3.Results The overa/1 response rate was 67%,71%,71% and 79% for sequential ehemo-radiotherapy group,concurrent chemo-radiotherapy group 1,2 and 3,respectively.There was a significant difference between the concurrent chemo-radiotherapy and sequential chemo-radiotherapy(P＜0.05).The 1-,3-and 5-year overall survival rate(OS) was 54%,8% and 4%;71%,17% and 8%;79%,17% and 8%;83%,46% and 13%,respectively for the four groups. The difference among all these groups(P=0.017) was significant.It was also significant between the con- current chemo-radiotherapy group 1 and 3 (P=0.046).The difference of distant metastasis rate among all the groups was statistically insignificant (P＞0.05) also was the difference of toxicity (P＞0.05),but the severe toxicity of concurrent chemo-radiotherapy groups 1 and 2 were higher than the sequential chemo-radio- therapy group and concurrent chemo-radiotherapy group 3.Conclusions Better locoregional progression- free survival and overall survival of unresectable stageⅢnon-small cell lung cancer could be achieved by concurrent chemo-radiotherapy as compared with sequential chemo-radiotherapy though at the expense of in- crease in toxicity.With the combination of concurrent chemo-radiotherapy and conforrnal radiotherapy,the o- verall survival rate could be much improved with miider toxicity.
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Objective To compare the efficacy between bronchial artery infusion (BAI) chemotherapy plus radiation therapy and systemic chemotherapy plus radiation for locally advanced non-small cell lung cancer (NSCLC). Methods One hundred and twenty-one patients with stage III NSCLC were randomized into treatment group(58 cases) and control group (63 cases). In the treatment group, all patients were administered with BAI for 2-3 sessions, followed by irradiation 4-7 days after BAI. In the control group, altogether 4-6 cycles of standard systemic chemotherapy were given. Radiation was delivered alternately between the cycles of chemotherapy. Results The short-term, long-term survival, median response duration and median survival time were similar between the two groups, except patients with stage Ⅲb who had a higher distant metastasis rate in the treatment group. The major side effects of chemotherapy and radiotherapy were hematological, gastrointestinal toxicities, pneumonitis, mediastinitis, and esophagitis, respectively. The side effects were milder, better tolerated and did not influence the regimen schedule in the treatment group, as compared with the control group. Seven patients withdrew from the control group, and in 28 patients, the scheduled chemotherapy and radiation was delayed or canceled. Conclusions Bronchial artery infusion plus radiation is more advantageous over systemic chemotherapy plus radiation in less toxicities, better compliance, shorter treatment courses and more cost-effectiveness.
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Objective To evaluate the effect and complication of inductio n chemot herapy combined with three-dimensional conformal radiation therapy (3DCRT) for l ocally advanced non small cell lung cancer (NSCLC). Methods Ninety-two such pa t ients were randomized into radiation therapy alone group(RT-, 50 patients) and i nduction chemotherapy combined radiotherapy group (CMT-, 42 patients). The indu c tion chemotherapy consisted of 2-4 cycles of platinum-based regimen. Results Th e overall median survival time was 15 months with 12 months in the RT group and 18 months in the CMT group(P=0.014)respectively. The 1-year o verall survival rates were 48.6% and 71.2% in RT and CMT group,respectively (P=0.004). The 2-year survival rates w ere 20.8% and 37.6% in RT and CMT group, respectively (P=0.0 41). Treatment was w ell tolerated and the toxicities were similar in either group. C onclusion The ad dition of induction chemotherapy to 3DCRT takes a survival advantage over 3DCRT alone for Stage Ⅲ NSCLC without increasing toxicities.
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Objective To evaluate the effect of chemoradiotherapy for stage Ⅲ non small cell lung cancer (NSCLC). Methods From January 1995 to December 2000, 132 patients with stage Ⅲ NSCLC were randomized into two groups: radiotherapy alone group (RT, 65 patioents), treated by conventional fractionation to a total dose of D_T 60?Gy～70?Gy/6 w～7 w; Chemoradiotherapy group (CRT, 67 patients), with chemotherapy given concomitantly or alternately with RT for at least 2 courses. Results Complete response rates of RT and CRT group were 14% and 27%, respectively. Disease progression rates of the two groups were 18% and 13%. The 1-,3-and 5-year survival rates were 62.1%, 22.7%, 9.3%and 52.7%, 9.3%, 6.9% in CRT and RT groups(P
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Objective To evaluate the effects of prophylactic cranial irradiation (PCI) on the survival and brain metastatic rates in patients with limited stage small cell lung cancer (SCLC) in complete remission. Methods Fifty one patients with limited stage SCLC in complete remission after chemoradiotherapy were randomly divided into prophylactic cranial irradiation (PCI) group (n=26) and control group (n=25). Patients in PCI group received irradiation to a dose of 25.2～30.6?Gy by 1.8～2.0?Gy per fraction. With the survival rates of the two groups analyzed by life table and compared by Log Rank test, the difference in cranial metastatic rates between the two groups were tested by ? 2 test. The patients' clinical features such as age, sex, effect of treatment before PCI were comparable between the two groups. Results The incidence of cranial metastasis was 3.8% in the PCI group as compared with 32.0% in the control group, with the difference significant (? 2=5.15, P= 0.02 ). The 1 , 3 , 5 year survival rates were 84.6%, 42.3%, 34.6% in the PCI group and 72.0%, 32.0%, 24.0% in the control group, with no significant difference between the two groups (? 2=2.25, P=0.13). No serious complications were observed in patients who received PCI. Conclusion For patients with limited stage SCLC complete response after chemoradiotherapy, PCI can decrease the incidence of cranial metastasis and tends to improve the survival rate.