oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciencesoncotomsk-41Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESВысокая суммарная доза облучения улучшает выживаемость больных локализованной формой мелкоклеточного рака легкого: результаты одноцентрового ретроспективного анализаHIGH TOTAL DOSE RADIATION IMPROVES SURVIVAL OF PATIENTS WITH LOCALLY ADVANCED SMALL CELL LUNG CANCER: RESULTS OF SINGLE-CENTRAL RETROSPECTIVE ANALYSISСкрипчакЮ. В.SkripchakYu. V.КононоваГ. В.KononovaG. V.АсахинС. М.AsakhinS. M.ЛевитМ. Л.LevitM. L.ГагаринаТ. Ю.GagarinaT. Yu.ПушкареваИ. К.PushkarevaI. K.ВальковМ. Ю,ValkovM. Yum_valkov@mail.ruГБОУ ВПО «Северный государственный медицинский университет»РоссияNorthern State Medical UniversityRussian FederationГБОУ ВПО «Северный государственный медицинский университет», ГБУ АО «Архангельский клинический онкологический диспансер»РоссияNorthern State Medical University, Arkhangelsk. Arkhangelsk Clinical Cancer CenterRussian FederationГБОУ ВПО «Северный государственный медицинский университет»РоссияNorthern State Medical University, Arkhangelsk. Arkhangelsk Clinical Cancer CenterRussian FederationГБУ АО «Архангельский клинический онкологический диспансер»РоссияArkhangelsk Clinical Cancer CenterRussian Federation20130902201601Сибирский онкологический журнал511Copyright © Скрипчак Ю.В., Кононова Г.В., Асахин С.М., Левит М.Л., Гагарина Т.Ю., Пушкарева И.К., Вальков М.Ю., 20162016Скрипчак Ю.В., Кононова Г.В., Асахин С.М., Левит М.Л., Гагарина Т.Ю., Пушкарева И.К., Вальков М.Ю.Skripchak Y.V., Kononova G.V., Asakhin S.M., Levit M.L., Gagarina T.Y., Pushkareva I.K., Valkov M.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/41

 Проведено ретроспективное изучение общей выживаемости больных Л-МРЛ, получавших не менее 2 курсов химиотерапии и дистанционную ЛТ в СОД не менее 50 Гр на первичный очаг. Больные группы СОДст (n=71) получили облучение грудной клетки в стандартно рекомендованной дозе, в группе СОДэск (n=69) суммарная доза составляла 60–74 Гр по биологическому эквиваленту. Лучевую терапию в режиме ускоренного фракционирования с эскалацией дозы (УГФЭД) чаще применяли в группе СОДэск. Более 1, 3 и 5 лет жили пациенты из группы СОДэск и СОДст соответственно в 54 % (95 % ДИ 42–65 %) и 32 % (95 % ДИ 23–44 %), р=0,11; в 25 % (95 % ДИ 16–36 %) и 1 % (95% ДИ 0–8 %), р=0,0003; в 17 % (95 % ДИ 10–28 %) и 0 % (95 % ДИ 0–5 %) случаях (р=0,0007). Медиана выживаемости в группах составила 14 (95 % ДИ 10–17 мес) и 9 (95 % ДИ 8–11 мес) мес, χ2=16,8, р<0,0001 соответственно. При многофакторном анализе только СОД 60 Гр и выше независимо снижала риск смерти (ОР 0,57 (ДИ 0,37–0,88), р=0,012). Увеличение СОД выше стандартно рекомендуемых 50–58 Гр может привести к улучшению выживаемости больных Л-МРЛ. Окончательное подтверждение этой гипотезы возможно только в рамках проспективного рандомизированного исследования.

The overall survival of patients with locally advanced small cell lung cancer who received at least 2 courses of chemotherapy and external beam radiation therapy at a total dose >50 Gy delivered to the primary tumor was retrospectively studied. Patients were dividedinto 2 groups. Patients in the standard treatment group (n=71) were treated to 50–58 Gy total dose. The dose escalation group (n=69) was treated to 60–74 Gy. Accelerated fractionation regimen in radiotherapy was more frequently given in dose escalation treatment group. The 1-, 3- and 5-year survival rates in the dose escalated and standard dose groups were respectively 54 % (95 % CI 42–65 %) and 32 % (95 % CI 23–44 %), р=0,11; 25 % (95 % CI 16–36 %) and 1 % (95% CI 0–8 %), р=0,0003; 17 % (95 % CI 10–28 %) and 0 % (95 % CI 0–5 %) (р=0.0007). The median survival was 14 months (95 % CI 10–17 months) in the dose escalated treatment group and 9 months (95 % CI 8–11months) in patients of the standard treatment group (χ2=16,8, р<0,0001). Multifactorial analysis showed that a total dose of ≥60 Gy resulted in reduction in risk of death (RR 0,57 (CI 0,37–0,88), р=0,012). Radiation dose escalation can result in improvement of local control for patients with locally advanced small cell lung cancer. Prospective randomized studies are required to finally confirm this hypothesis.

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The authors declare that there are no conflicts of interest present.