三维适形放射治疗局部晚期非小细胞肺癌预后因素分析  

Prognosis of locally advanced non small cell lung cancer treated with three dimentional conformal radiotherapy

作　　者：朱向帜[1] 王绿化[1] 欧广飞[1] 周宗玫[1] 陈东福[1] 肖泽芬[1] 冯勤付[1] 张红星[1] 汪楣[1] 殷蔚伯[1] 

机构地区：[1]中国医学科学院肿瘤医院肿瘤研究所,南京江苏省肿瘤医院放疗科210009

出　　处：《中华肿瘤杂志》2007年第10期748-753,共6页Chinese Journal of Oncology

基　　金：卫生部科研基金资助项目(WKJ2005-3-006);首都医学发展研究基金资助项目(20021016)

摘　　要：目的评估三维适形放疗治疗局部晚期非小细胞肺癌的疗效、毒性及预后因素。方法采用三维适形放射治疗经组织学证实的局部晚期(ⅢA或ⅢB期)非小细胞肺癌患者113例,分析患者的1、2、3年生存率和中位生存期及预后因素。结果全组1、2、3年生存率分别为60.7%、31.6%和22.4%。中位生存期为17个月,其中单独放疗组16个月,序贯放化疗组18个月,同步放化疗组16个月。单因素分析显示,治疗前胸背痛、卡氏评分、血红蛋白、白蛋白水平、大体肿瘤体积(GTV)及近期疗效是影响预后的因素(P值分别为0.033、0.000、0.042、0.028、0.024和0.021);多因素分析显示,疗前卡氏评分是肺癌预后的独立因素。结论三维适形放射治疗局部晚期非小细胞肺癌显示了较好的疗效,放疗前卡氏评分是影响局部晚期非小细胞肺癌预后的主要因素。Objective To summarize our experience and evaluate the prognostic factors of locally advanced non small cell lung cancer （LA-NSCLC） treated with three dimentional conformal radiotherapy （3D-CRT）. Methods 118 patients with stage ⅢA/ⅢB non small cell lung cancer were treated with 3D- CRT from Nov. 2001 to Mar. 2005. 113 patients with complete clinical data were eligible for analysis, 45 of them received radiotherapy alone; 39 were treated by concurrent chemoradiation with paclitaxol plus carboplatin in 32 patients and topotecan in 7 patients, and 29 by sequential chemoradiation with platinumbased regiment in most of them. The dose of radiation for the thoracic field ranged from 26 Gy to 75 Gy with a median dose of 60 Gy. GTV and PTV were collected from the 3D treatment plans in 79 and 101 patients, respectively. Overall survival （OS） was calculated using the Kaplan-Meier method. Comparisons among the curves were made using a two-tailed long-rank test. The Cox model was used for multivariate analysis. Results The 1-,2- and 3-year overall survival rate was 60.7% ,31.6% and 22.4%, respectively, with a median survival time of 17 months. In univariate analysis, the following characteristics were significantly associated with longer survival： absence of chest pain, good karnofsky performance status （KPS）, albumin 〉 4.2 g/L, hemoglobin≥140 g/L （male） or 130 g/L（ female）, response to radiotherapy and GTV 〈 100 cm^3. However,multivariate analysis revealed that only good KPS was an independent risk factor predicting the survival. Conclusion Three-dimensional conformal radiotherapy is effective in the treatment of locally advanced non-small cell lung cancer with acceptable complications. Karnofsky performance status is the only independent prognositic factor.

关 键 词：三维适形放射治疗 非小细胞肺癌 预后 

分 类 号：R734.2[医药卫生—肿瘤]