| Purpose:Lung cancer remains the leading cause of cancer related mortality.Compared with other malignant tumors,its morbidity and mortality are the highest in the world.In the increasing patients with lung cancer every year,about 15% patients are diagnosed with small cell lung cancer(SCLC).SCLC is a type of cancer with early metastasis,fast growth,and strong aggressiveness.It is very sensitive to both thoracic radiotherapy(RT)and chemotherapy(CT).However,there are no good treatments so far and metastasis or recurrence appears after the first-line therapy in most of the patients.We studied thoracic radiotherapy(RT)programs for limited-stage small cell lung cancer(LSCLC)and found that early stage synchronic hyper fraction radiotherapy combined with chemotherapy had good effects on prognosis.Chemoradiotherapy(CRT)is a standard therapy for patients with LSCLC.Although therapies based on CT that are combined with RT improve the curative effects for SCLC,they cannot increase the overall survival(OS),the local recurrence rate and the distant metastatic rate are still high.Numerous of clinical studies proved that different patients with LSCLC take the same treatment of CRT,but their prognosis and OS are different.The study found that prognosis and OS of patients were related to the combination mode of CT and RT,the opportunity when RT involves,dose of RT,fraction mode,adverse reaction after RT etc.So all the researchers dedicate themselves into solving these problems to find better treatments to provide evidences with the evidence-based medicine.Whether the LSCLC patients with ipsilateral pleural effusion can benefit from CRT is not clear.We studied the LSCLC patient with ipsilateral pleural effusion according to the inclusion and exclusion criteria.After 2-4 cycles treatment of CT,we evaluated the effect.The patients received sequential thoracic radiotherapy to enhance CT effect,original CT,or another treatment of CT according to the control level of pleural effusion.Then we studied the remission rate(RR),median survival time(MST),and OS of 1,2 and 3-year of the different treatment mode.We found the reference information for the LSCLC clinical treatment mode from the curative effects and prognosis of the patients received CRT according to the retrospective analysis.Methods: 58 LSCLC patients with ipsilateral pleural effusion from the oncology department of Bethune International Peace Hospital PLA from Jan.2008 to Jan.2012 were enrolled.They were proved by pathology and imaging in accordance with the inclusion and exclusion criteria.We evaluated the effect every 2 cycles depending on the absorption levels of pleural effusion.After 2 to 4 cycles of inducing CT,the patients were divided into 3 groups according to the absorption levels of pleural effusion and the following treatment.Patients with complete absorption of pleural effusion who received thoracic RT next and then continued consolidating CT were identified as Group A(22).Group B(17)included patients with complete absorption of pleural effusion who were unable or unwilling to receive RT and followed the original CT.Patients with incomplete absorption or increasing of pleural effusion,or pejorative effect evaluation were in Group C(19).The general data of three groups were processed with statistics.The difference was equally comparable and no statistically significant.SPSS17.0 statistical software was used to perform statistical analysis.Measurement data were analyzed by independent t-test.The numeration data were analyzed by Chi-square test.The survival rate was calculated by Kaplan-Meier method and compared by log-rank test.P<0.05 meant that the difference was statistically significant.The LSCLC patients with ipsilateral pleural effusion were proved by pathology and imaging and had measurable or evaluable niduses after magneticresonance imaging(MRI)or CT.Patients who could not meet the above conditions or were lost to follow-up were excluded.Result:1 Short term curative effect evaluationWe evaluated the curative effects of all patients after inducing CT.31 patients achieved complete response(CR),14 patients achieved partial response(PR),6 patients received stable diseases(SD),7 patients received progressive diseases(PD),and remission rate(RR)was 77.6%.Pleural effusion was completely absorbed after inducing CT in 39 patients.Then we divided the patients into 3 groups.After the treatment finished,we evaluated the short term curative effect.RR of group A was 81.8%,group B was 76.5%,and group C was 73.7%.Comparative differences among the 3 groups were not statistically significant.2 Long term curative effect evaluationThe median survival time(MST)of all patients was 18 months(95% CI: 14.3-21.7).1,2 and 3-year OS were 70.0%,31.3% and 17.3% respectively.The MST of the 3 groups were 21.2,16.4 and 14.1 months respectively.There were statistical significant differences among them(P=0.003).MST of group A was longer than group B and Group C(P=0.007,P=0.002),and there was no statistical significant difference between group B and group C(P=0.718).1-year OS of the 3 groups were 81.8%,64.7% and 57.9%.There were statistical significant differences among them(P=0.014).OS of group A was higher than group B and Group C(P=0.033,P=0.007),and there was no statistical significant difference between group B and group C(P=0.614).2-year OS of the 3 groups were 45.5%,24.8%,and 18.9%.There were no statistical significant differences among them(P=0.371).3-year OS of the 3 groups were 26.5%,16.5%,and 6.3%.There were statistical significant differences among them(P=0.027).OS of group A was higher than group B and Group C(P=0.018,P=0.022),and there was no statistical difference between group B and group C(P=0.894).Conclusion : Our study suggests that CRT combination is a better selection than CT alone in LSCLC patients with ipsilateral pleural effusion whose pleural effusion was complete absorbed after first-line CT.The patients achived a better OS. |
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