Objective To explore the effect and side effects of induction chemotherapy followed by chemoradiotherapy for limited-disease small cell lung cancer ( LD-SCLC) patients with ipsilateral pleural effusion. Methods From January 200S to May 2009, 32 LD-SCLC patients with ipsilateral pleural effusion were treated with induction chemotherapy first. The regimen was taken as follow: etoposide 100 mg iv. D, -d,, cisplatin 25 mg/m2 iv. D, -d, or CBP AUC 4 iv. D,. Three weeks was a cycle. According to pleural effusion status after 2-4 cycles induction chemotherapy, patients got disappearance of pleural effusion after chemotherapy were underwent chest radiotherapy with TRT (50 Gy/25 fraction) or same chemotherapy regimen; patients without disappearance or increasing of pleural effusion after chemotherapy were given same regimen chemotherapy. Therapeutic effect was evaluated every two cycle according to RECIST 1. 0 and side-effects were evaluated every cycle according to NCI-CTC AE Grades. All patients were followed up, and the median follow-up time was 26 months. Results The response rate of patients was 80. 7% (42/52) after induction chemotherapy and 32 patients got disappearance of pleural effusion. The median survival time, 1- and 2-year survival rates were 15.4 months, 76. 9% (40/52) and 38. 5% (20/52) respectively. The median survival time, 1- and 2-year survival rates of patients with pleural effusion remission received chest radiotherapy (n =20) , patients with pleural effusion remission received chemotherapy(n =14) and patients without pleural effusion remission received chemotherapy ( n = 18) were 21.5 months, 14.4 months,12.5 months, 80.0%, 64. 3% ,55. 6% and 35% ,21. 4% ,11. 1% , respectively. Main side effects were grade 1-2, including myelosuppression, fatigue, nausea and vomiting. No therapeutic related death was occurred. Conclusion Induction chemotherapy plus chemoradiotherapy has shown better effect in prolonging survival of SCLC patients with ipsilateral pleural effusion than chemotherapy alone. The patients with de-creased ipsilateral pleural effusion may receive benefit from subsequent TRT treatment.%目的 探讨诱导化疗与放化疗联合治疗合并同侧胸腔积液的局限期小细胞癌患者的疗效及不良反应.方法2005年1月至2009年5月收治52例局限期小细胞肺癌合并同侧胸腔积液的初治患者,先给予诱导化疗,具体为:依托泊苷100mg/日静滴,d1～d5；顺铂25mg/m2静滴,d1～d3;或卡铂(AUC =4)静滴,d1,3周为1周期.诱导化疗2～4周期后,对胸腔积液消失者分别行胸部放疗或继续原方案化疗,胸部放疗剂量为50Gy/25f;对胸腔积液未消失或增加者继续行原方案化疗.每2个周期按照RECIST 1.0评价疗效,每周期按照美国国立研究所(NCI)毒性分级3.0版评价毒副反应,并进行生存随访,中位随访时间为26个月.结果52例患者诱导化疗的有效率为80.7% (42/52),34例患者(65.3%)化疗后胸腔积液消失.全组中位生存期为15.4个月,1年和2年生存率分别为76.9%(40/52)和38.5%(20/52).诱导化疗后行胸部放疗(n=20)、胸腔积液消失未行放疗(n=14)、胸腔积液未消失(n=18)3组患者的中位生存期分别为21.5、14.4和12.5个月,1年生存率分别为80%、64.3%和55.6%,2年生存率分别为35%、21.4%和11.1%.全组患者的主要不良反应为骨髓抑制、乏力和恶心呕吐,以1～2级为主,未发生治疗相关性死亡.结论合并同侧胸腔积液的局限期小细胞肺癌化疗后联合胸部放疗生存期优于单纯化疗,诱导化疗后胸腔积液消失的患者有可能从胸部放疗中受益.
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