Experiences of Radiotherapy on Extrapulmonary Small Cell Carcinoma

非肺部小細胞癌的放射治療經驗

薛尉廷(Wei-Ting Hsueh) ； 蘇五洲(Wu-Chou Su) ； 陳芬芬(Fen-Fen Chen) ； 陳海雯(Helen H. W. Chen)

《放射治療與腫瘤學》 12卷2期 (2005/06) Pp. 93-101

https://doi.org/10.6316/TRO/200512(2)93

摘要

目的：以回溯性的方式報告非肺部小細胞癌之放射治療經驗。
村料與方法：從1991年到2004年，共有21位組織切片證實為非肺部小細胞癌的病人在本院接受放射線治療。其納入研究之條件為在肺部之外的腫瘤以病理組織切片證實為小細胞癌、且在診斷時病人的胸部X光和電腦斷層攝影必須為正常、其痰液細胞學化驗或支氣管鏡檢查必須沒有異常發現，以回溯性的病歷調閱方式比較其臨床治療效果。
結果：非肺部小細胞癌的原發病灶為：婦科部位7位、鼻腔副鼻竇和唾液腺6位、膀胱3位、胃腸消化道臟器3位、乳房和鎖骨下軟組織各一位病人。其中5位病人為在診斷之際為擴散型，16位為局限型。在這16位原先為局限型的病人中，11位一開始就接受局部放射治療，另外有5位病人則等到疾病復發或轉移時才接受放射治療。病人的二年整體存活率在擴散型病人為0%，在局限型病人為49.2%。經過追蹤，總共17位病人(81%)發生遠端轉移。放射治療對擴散型和本為局限型後來產生疾病復發或轉移的病人有60%的反應率，對11位局限型初始就接受局部放射治療的病人，其中6位先接受手術再接受局部放射治療（或合併化學治療），後來有一位病人發生局部復發；另外5位初始就接受局部放射治療（或合併化學治療）的病人，其放射治療的反應率為100%，不過後來其中4位發生局部復發（中數：8個月）。這11位病人的二年局部腫瘤控制率和無疾病存活率分別為53%和27%。
結論：非肺部小細胞癌對放射治療的反應很好，這個疾病容易早期即發生遠端轉移和局部復發，需要更多更積極的合併治療。

關鍵字

非肺部小細胞癌 ； 放射治療 ； 臨床治療成果

並列摘要

Purpose: To report our institution's experience of radiotherapy (RT) on extrapulmonary small cell carcinoma (EPSCCA).
Materials and Methods: Between 1991 and 2004, 21 patients with tissue-proven EPSCCA received RT in our hospital with either curative or palliative intents. Study eligibility required that the patients had pathologically-proven small cell carcinoma in sites other than the lung, a normal chest radiograph and/or computed tomography of the chest, and a normal sputum cytology or negative bronchoscopic findings at diagnosis. The medical records of each patient were reviewed retrospectively and clinical outcomes were compared.
Results: Primary sites of EPSCCA in our series included: 7 patients in the gynecological system, 6 in head and neck regions, 3 in urinary bladder, 3 in the gastrointestinal system, 1 in the breast, and 1 in the infra-clavicular soft tissue. Five patients had extended disease (ED) and 16 had limited disease (LD) at initial work-up. RT was delivered to 11 of 16 patients with LD as part of the initial primary therapy, and to 5 with relapse or metastasis as salvage or palliation. The 2-year overall survival for ED and LD EPSCCA were 0% and 49.2%, respectively. During follow-up, a total of 17 (81%) of the 21 patients developed distant metastases. There was a 60% response rate for those patients with ED at diagnosis or LD with relapse or metastasis when RT initiated. For the 11 patients with LD and receiving RT as part of the initial primary therapy, one of six patients receiving surgery followed by adjuvant RT (with or without chemotherapy) developed local recurrence. The remaining five who received RT alone or chemotherapy and RT had a 100% response rate. However, four of them developed local relapses at a median duration of 8 months. The 2-year local relapse-free and disease-free survivals for patients with LD were 53% and 27%, respectively.
Conclusion: EPSCCA was sensitive to radiotherapy. Easily distant metastasis and local recurrence of the disease warrant more aggressive combination therapy.

並列關鍵字

Extrapulmonary small cell carcinoma ； Radiotherapy ； Clinical Outcome