| Objective:Small cell lung cancer (SCLC) is a highly aggressive tumor, on accountof its elevated doubling-time, highly appreciation index and early metastaticdissemination. The multimodality treatment of radiotherapy combined withchemotherapy is the standard treatment mode of patients with small cell lung cancer.Because of the high risk of brain metastasis,prophylactic cranial irradiation(PCI) shouldbe part of the standard management of these patients. The aim of this study is toretrospectively review the prognostic factors for76patients who underwent themultimodality treatment of radiothrapy combined with chemotherapy.All the factorswere analyzed by Kaplan-Meier and COX multivariate propotional hazardsmodel,which procides evidence for prognosis.Methods: From October2004to December2012, clinical data were collectedfrom76patients admitted in our hospital who with SCLC that all had been diagnosedby pathology or cytology and underwent multimodality therapy radiotherapy combinedwith chemotherapy.The male is60cases (78.9%), female is16(21.1%); the age is35to80years old, the median age is57years old. SCLC is classified as limited or extensivedisease according to the Veterans Administration Lung Cancer Study GroupClassification. The LD is57cases (75%), ED is19cases (25%). According to thetiming in which radiotherapy was administered in,the patients is divided into threegroups.The early radiatherapy group was defined as between the second and the thirdcycle of chemotherapy. The middle radiatherapy group was defined as between the fifthand the sixth cycle of chemotherapy. The late radiotherapy group was defined as aftercompletion of six chemotherapy cycles. According to the total doses of radiation, thepatients were divided into two groups,4500cGy-5400cGy and equal or more than 5400cGy. According to whether do PCI therapy, the patients were divided into twogroups,PCI or no-PCI. We used SPSS17.0statistical package to analysis Single factorof survival with Kaplan-Meier and Log rank test. And we calculated survival rates withlife-table method (Life-Tables).Significant factors are analyzed by COX multivariatepropotional hazards model. Statistical results to P＜0.05as significantly.Results:(1) Patients were followed up for12-86months.The follow-up rate was100%.1year survival rate was72.4%(55/76), and2years survival rate was42.1%(32/76),5years survival rate was21.1%(16/76). The median survival time was17months.In57cases of patients with limited small cell lung cancer,1year survival ratewas87.7%(50/57), and2years survival rate was50.9%(29/57),5years survival ratewas28.1%(16/57). In19cases of patients with extensive small cell lung cancer,1yearsurvival rate was26.3%(5/19), and2years survival rate was10.5%(2/19),5yearssurvival rate was0%(0/19).（2）The side effects of treatment in all patients: grade1acute radiation injury of skin accounted for65.79%(50/76), more than grade2did notoccur; grade2-3acute radiation pneumonitis accounted for10.53%(8/76);grade2acuteradiation esophagitis accounted for6.58%(5/76), more than grade3did not occur;grade1-3acute hematologic toxicity accounted for22.37%(17/76); grade2late radiadtionpneumonitis accounted for7.89%(6/76).(3) The results of univariate analysis:Themedian survival time of limited small cell lung cancer was25months,versus7monthsof extensive,P=0.000.The results were significant differences.The median survival time of the early radiatherapy group was28months,and25months of the middle radiatherapy group,18months of the late radiatherapy group.P=0.000.The results were significant differences. The median survival time of PCI was30months,versus16months of no-PCI. The results were significant differences.Age(P=0.073), gender (P=0.142),the total doses of radiotherapy(P=0.633) were not theprognostic factors in small cell lung cancer in this research.(4) Multivariate analysisshowed that PCI(P=0.001) was the independent prognostic factors of survival forpatients who underwent the multimodality treatment of radiothrapy combined withchemotherapy.Conclusion:1.Stage was the prognostic factor in small cell lung cancer.Univariateanalysis indicated a statistically significant benefit of LD over ED of small cell lungcancer according to the two stage classification.2. The timing of radiotherapy was the prognostic factor in small cell lung cancer.The early radiatherapy group got better response than the middle group, after completion of six chemotherapy cycles was the worst.3. The total doses of radiation for equal or more than5400cGy did not increase theefficacy of treatment moreover the group of more than5400cGy increased the radiationinjury.4.PCI can improve the surivival rate of SCLC. Multivariate analysis showed thatPCI was the independent prognostic factor.5. Age,gender were not the prognostic factors in small cell lung cancer in thisresearch.6. LD group and ED group were not separately to stugy in this retrospectiveresearch, therefore the outcome may had been affected. It remains to be furtherexperimental study. |
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