medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-9-190-195medsovet-5735Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHСобственный опыт химиолучевой терапии у больных локализованным мелкоклеточным раком легкого. Ретроспективная оценкаFirsthand experience of chemoradiotherapy in patients with localized small cell lung cancer. Retrospective assessmentКузьминовА. Е.KuzminovA. E.

Кузьминов Александр Евгеньевич, к.м.н., научный сотрудник отделения лекарственных методов лечения (химиотерапевтического №17)

115478, Москва, Каширское шоссе, д. 24

Aleksandr E. Kuzminov, Cand. of Sci. (Med.), Researcher of the Department of Medicinal Treatment Methods (Chemotherapeutic No. 17)

24, Kashirskoye Shosse, Moscow, 115478

alexkouzminov@mail.ruhttps://orcid.org/0000-0002-5570-684XБорисоваТ. Н.BorisovaT. N.

Борисова Татьяна Николаевна, к.м.н., старший научный сотрудник радиологического отделения Научно-исследовательского института клинической и экспериментальной радиологии

115478, Москва, Каширское шоссе, д. 24

Tatiana N. Borisova, Cand. of Sci. (Med.), Senior Researcher, Department of Radiological Research Institute of Clinical and Experimental Radiology

24, Kashirskoye Shosse, Moscow, 115478

tborisova111@gmail.comhttps://orcid.org/0000-0002-6244-4294БредерВ. В.BrederV. V.

Бредер Валерий Владимирович, д.м.н., ведущий научный сотрудник

РИНЦ: SPIN: 9846-4360

115478, Москва, Каширское шоссе, д. 24

Valeriy V. Breder, Dr. of Sci. (Med), Leading Researcher

24, Kashirskoye Shosse, Moscow, 115478

vbreder@yandex.ruhttps://orcid.org/0000-0002-2154-3376РеутоваЕ. В.ReutovaE. V.

Реутова Елена Валерьевна, к.м.н., старший научный сотрудник

115478, Москва, Каширское шоссе, д. 24

Elena V. Reutova, Cand. of Sci. (Med.), Senior Researcher

24, Kashirskoye Shosse, Moscow, 115478

evreutova@rambler.ruБарболинаТ. Д.BarbolinaT. D.

Барболина Татьяна Дмитриевна, врач-онколог, отделение лекарственных методов лечения (химиотерапевтическое) №17

115478, Москва, Каширское шоссе, д. 24

Tatyana D. Barbolina, oncologist, the Oncological Department of Medical Treatment Methods (Chemotherapeutic No. 17)

24, Kashirskoye Shosse, Moscow, 115478

katan4ik@list.ruhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович, д.м.н., заведующий онкологическим отделением лекарственных методов лечения (химиотерапевтическое) №17

115478, Москва, Каширское шоссе, д. 24

Konstantin K. Laktionov, Dr. of Sci. (Med), Head of the Oncological Department of Medical Treatment Methods (Chemotherapeutic No. 17)

24, Kashirskoye Shosse, Moscow, 115478

lkoskos@mail.ruНациональный медицинский онкологический центр им. Н.Н. БлохинаРоссияN.N. Blokhin National Medical Research Center of OncologyRussian Federation20202907202009190195Copyright © Кузьминов А.Е., Борисова Т.Н., Бредер В.В., Реутова Е.В., Барболина Т.Д., Лактионов К.К., 20202020Кузьминов А.Е., Борисова Т.Н., Бредер В.В., Реутова Е.В., Барболина Т.Д., Лактионов К.К.Kuzminov A.E., Borisova T.N., Breder V.V., Reutova E.V., Barbolina T.D., Laktionov K.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5735

Введение. В современных рекомендациях по лечению локализованного мелкоклеточного рака легкого (МРЛ) предпочтение отдается так называемой «ранней» химиолучевой терапии (ХЛТ), которая имеет ряд ограничений из-за выраженной токсичности. Что касается профилактического облучения головного мозга (ПОГМ), то, несмотря на достоверные данные о необходимости его проведения, ПОГМ не удается провести всем больным в связи с частыми отказами самих пациентов и наличием сопутствующей неврологической патологии. В статье представлен собственный опыт терапии больных локализованным МРЛ с анализом накопленных данных. Материалы и методы. Проведена ретроспективная оценка результатов лечения больных локализованным МРЛ. В анализ включены данные о 63 пациентах. 47 больных получили одновременную ХЛТ, 16 – последовательную. Сначала оценены результаты одновременной ХЛТ. «Раннюю» ХЛТ получили 27 человек, «позднюю» ХЛТ – 20 человек. Результаты.Медиана выживаемости без прогрессирования (ВБП) в группе «ранней» ХЛТ составила 9,5 мес. (95% ДИ 4,2–14,9), а в группе «поздней» ХЛТ – 11,8 мес. (6,4–17,1). Различие статистически не достоверно. Медиана общей выживаемости (ОВ) оказалась больше в группе «ранней» ХЛТ, несмотря на то, что ВБП была меньше. Медиана ОВ в группе «ранней» ХЛТ составила 27,9 мес. (95% ДИ 2,1–53,7), а в группе «поздней» – 24,8 мес. (95% ДИ 13,3–36,1). Различие статистически не достоверно. ПОГМ в группе больных с одновременной ХЛТ получили 26 больных (55%). Результаты ОВ показывают крайне важное значение ПОГМ у больных локализованным МРЛ. Медиана ОВ у больных, получивших ПОГМ, составила 45,9 мес. (95% ДИ 21,2– 70,5), у больных не получивших ПОГМ, – 21,7 мес. (95% ДИ 14,3–29). Различие статистически достоверно, р = 0,01. Что касается осложнений, то в группе «ранней» ХЛТ чаще отмечались эзофагиты 2 ст. – 57% в группе «ранней» ХЛТ и 42% в группе «поздней» ХЛТ, эзофагит 3 ст. отмечен у 1 больного в каждой группе, различие не достоверно. Гематологическая токсичность 3–4 ст. отмечена у 5 больных в группе «ранней» ХЛТ и у 2 больных в группе «поздней» ХЛТ, различие также не достоверно. Медиана ОВ в группе больных, получивших последовательную ХЛТ, составила 27,1 мес. (95% ДИ 18,2–37,6), а медиана ОВ в группе больных, получивших одновременную ХЛТ, – 27,9 мес. (95% ДИ 18,9–36,9). Выводы. Полученные данные показывают недостоверное преимущество «ранней» ХЛТ перед «поздней» относительно ОВ. При этом различия в медиане времени до прогрессирования, как местного, так и общего, не было получено. Крайне важным представляется проведение ПОГМ у больных локализованным МРЛ, т. к. выживаемость у оцененной группы больных увеличилась вдвое.

Introduction. In modern recommendations for the treatment of localized small cell lung cancer (SCLC), preference is given to socalled «early» chemoradiotherapy (CRT), which has a number of limitations due to its pronounced toxicity. With regard to prophylactic brain irradiation (PBI), although there is reliable evidence that it is necessary, PBI cannot be performed on all patients due to the frequent refusals of the patients themselves and the accompanying neurological pathology. The article presents own experience of therapy of patients with localized SCLC with the analysis of accumulated data. Materials and methods. Retrospective assessment of treatment results of patients with localized SCLC was carried out. The analysis included data on 63 patients. 47 patients received simultaneous CRT and 16 patients received consecutive CRT. The results of simultaneous CRT were evaluated first. 27 patients received “early” CRT, while 20 patients received “late” CRT. Results. The PFS median for the group of early CRT was 9.5 months (95% CI 4.2–14.9) and for the group of “late” CRT it was 11.8 months (6.4–17.1). The difference is statistically unreliable. The median of total survival rate was higher in the group of “early” CRT, despite the fact that PFS was lower. The OS median in the group of “early” CRT was 27.9 months (95% CI 2.1–53.7), and in the group of “late” – 24.8 months (95% CI 13.3–36.1). The difference is statistically unreliable. Prophylactic brain irradiation (PBI) in the group of patients with simultaneous CRT was received by 26 patients (55%). The results of overall survival show the crucial importance of PBI in patients with localized SCLC. The OS median in patients who received PBI was 45.9 months (95% CI 21.2–70.5), in patients who did not receive PBI – 21.7 months (95% CI 14.3–29). The difference is statistically significant, p = 0.01. As for complications, 2nd degree esophagitis was recorded more frequently in the group of early CRT – 57% in the group of early CRT and 42% in the group of late CRT, 3rd degree esophagitis was recorded in 1 patient in each group, the difference is not significant. Grade 3–4 hematological toxicity was observed in 5 patients in the group of early CRT and 2 patients in the group of late CRT, the difference is also unreliable. The OS median in the group of patients who received consecutive CRT was 27.1 months (95% CI 18.2–37.6), and the OS median in the group of patients who received simultaneous CRT was 27.9 months (95% CI 18.9–36.9). Conclusions. The obtained data show an unreliable advantage of the “early” CRT over the “late” CRT in terms of overall survival. However, no differences in median time before progression of both local and general ones were obtained. It is extremely important to perform PBI in patients with localized SCLC, as the survival rate in the assessed group of patients doubled.

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