The Research Of Small Cell Lung Cancer Treatment And Prognosis

Objectives:1. We carried out a prospective phase II study of patients with limited stage small celllung cancer (LS-SCLC) assigned to receive stereotactic body radiotherapy (SBRT)concurrently with cisplatin-based chemotherapeutic regimen with OS and PFS as theprimary study endpoints.2. To study the expression of Nm23-H1gene product and its relationship withprognosis in patients with small cell lung cancer.Methods:1. Patients with pathologically proven LS-SCLC received4to6cycles of cisplatin75mg/(m2/d) given intravenously on day1and etoposide80mg/(m2/d) given intravenously ondays1to5, both at3-weekly intervals. SBRT at a dose of4000-4500cGy in10fractionswas given concurrently with chemotherapy starting on day1. The Kaplan-Meier curve andlife tables were used to describe survival data. Adverse events were evaluated according tothe Common Terminology Criteria for Adverse Events version of The Radiation TherapyOncology Group (RTOG).2. The expression of Nm23-H1was detected by immunohistochemistry in71smallcell lung cancer tissue samples and22normal lung tissue samples. According to theirpositive percentage and staining intensity, they were divided into two groups: highexpression group and low expression group. The correlation of Nm23-H1expression withclinicopathology and prognosis was performed by SPSS19.0.Results:1. Twenty-nine patients were included and followed up for a median duration of19(range,10to85) months. The median OS was27(95%CI:20.2to33.8) months.Themedian PFS was12(95%CI:4.2to19.8) months. No grade4or5adverse events wereobserved. Grade3adverse events occurred in only5(13.8%,5/29) patients. Neutropenia of any grade was observed in6(15%,6/29) patients, with grade3neutropenia only seen in1(3.4%,1/29) patient.2. The expression level of Nm23-H1was higher in normal tissue samples than in smallcell lung cancer(90.9%vs.57.7%, P=0.004); It was higher in limited stage than in extensivestage small cell lung cancer(66.7%vs.39.1%, P=0.028). Multivariate logistic regressionshowed the Nm23-H1expression was an independent protect factor for the metastasis ofsmall cell lung cancer (OR=0.32,95%CI=0.12-0.90, P=0.031). The subcellular location ofthe Nm23-H1showed no difference between normal lung tissues and cancer tissues, neitherbetween different stages. In the survival analysis, Nm23-H1positive expression was foundto be related with decreased median Overall survival than negative expression patients(P=0.046). The stage was also associated with mOS that the patients with limited focistayed longer than those with metastatic disease (HR=1.85，95%CI=1.03-3.33, P=0.041).Conclusions:1. The combination of chemotherapy and early concurrent SBRT could be a safe andeffective treatment for LS-SCLC patients. Our study confirmed that SBRT with concurrentchemotherapy is another new treatment option for LS-SCLC patients.2. Nm23-H1was low expression in SCLC cancer tissues, and mainly in cytoplasma.The expression played an important role in the metastasis of SCLC, and may be a predictivefactor for the poor outcome of SCLC.