局限期小细胞肺癌放疗中预防野照射和累及野照射的疗效分析

局限期小细胞肺癌综合治疗中采用三维适型或调强放疗技术，按不同照射范围分为累及野照射和预防野照射2个组进行比较，分析不同照射野对预后的影响。 67例局限期小细胞肺癌患者，随机分为累及野照射组37例和预防野照射组30例。累及野照射组照射范围包括化疗前CT所见肿瘤及转移淋巴结范围，预防野照射组照射范围包括原发灶、同侧肺门、纵隔及锁骨上淋巴引流区。两组均采用三维适形或调强技术，放疗剂量为DT50Gy～66Gy/5周～6周。结果全组总有效率为82.1%，局部复发率为29.9%，远处转移率为56.7%，1年、2年、3年生存率分别为68.7%、36.2%和20.1%，分组比较以上指标均无显著性差异（P＞0.05）。而两组病例急性放射性肺炎和食道炎发生率分别为5.4%、16.7%和2.7%、20.0%，累及野照射食管炎发生率显著低于预防野（P＜0.05）。

Elective Nodal Irradiation versus Involved Field Irradiation for Patients with Limited--stage Small Cell Lung Cancer

To compare the prognosis of elective nodal irradiation （ENI） versus involved field irradiation （IFI） of 3DCRT or IMRT for limited-stage small cell lung cancer （LSCLC） . From June 2005 to July 2008, 67 patients with LSCLC were randomized into two groups： 30 patients with ENI and 37 patients with IFI. Radiation was started after 2-4 cycles of chemotherapy, and all patients received 3DCRT or IMRT. The total dose was 50-66Gy/5-6weeks. The ENI fields covered the primary tumor, draining hilar lymphatics, partial mediastinum and bilateral supraclavicular areas, and the IFI covered only the primary tumor and the originally involved lymph node regions.The overall response rate （ CR＋PR ） was 82.1%. The median survival time （MST） was 16.8 months. The 1, 2 and 3-year survival rates were 68.7%,36.2%,20.1%. The frequencies of local recurrence were 29.2%,and the distant metastasis was 56.7%. No differences were found between ENI and IFI groups. Only the acute radiation esophagitis incidence of ENI （20.0%） was significantly high than that of IFI （2.7%）.There was no obvious difference observed in comparing the survival,recurrence and metastasis between ENI and IFI groups in this study, while the radiation induced esophagitis is lower in IFI than in ENI.