高龄早期非小细胞肺癌单纯放射治疗临床观察  

Radiotherapy in elderly patients with early stage non-small cell lung cancer

作　　者：曲宝林[1] 王迎选[1] 杨东[1] 

机构地区：[1]解放军总医院放疗科,北京100853

出　　处：《生物医学工程与临床》2008年第2期138-142,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的观察分析70岁以上早期(Ⅰ、Ⅱ期)非小细胞肺癌患者接受单纯放射治疗后的临床疗效及死亡原因。方法选择1992年至2003年48例70岁以上早期非小细胞肺癌患者,均为男性,年龄70～94岁,平均年龄78岁。Ⅰ期患者38例,Ⅱ期10例。既往有肺部阻塞性疾病26例,心血管疾病18例,糖尿病18例,脑血管疾病2例,共有15例(31.3%)患者同时合并两种或以上疾病。全部患者接受放射治疗,照射剂量60～66Gy(平均64Gy)/30～33次,常规分割照射2Gy/次。结果治疗后总有效率为58.3%。存活时间3～90个月(平均30.5个月),1、2、3年存活率分别为56.3%、45.8%、39.6%,平均疾病专项生存时间34.0个月,1、2、3年疾病专项生存率分别为62.6%、53.0%、45.8%。6例(12.5%)老年患者在放射治疗结束后3～6个月出现局灶性放射性肺炎,27例(56.3%)患者出现2级以下自限性的放射性食管反应。死亡的30例患者中,16例(53.3%)死于肺部感染、呼吸衰竭;9例(30.0%)死于肿瘤局部复发或广泛转移;3例(10.0%)死于心脑血管疾病;1例(3.3%)死于消化道大出血;1例(3.3%)死于甲状腺未分化癌。结论单纯放射治疗高龄早期非小细胞肺癌的临床疗效可靠且毒副反应较小,并且不会降低患者生活质量。对于高龄患者尤其是对于不能耐受或拒绝手术的高龄患者是很好的选择。从死亡原因分析,肺部感染仍是致死的重要因素。Objective To analyze the efficacy of radiotherapy alone in elderly patients with early stage （ Ⅰ/Ⅱ ） nonsmall cell lung cancer and the cause of death. Methods From 1992 to 2003,48 patients with non-small cell lung cancer （male,aged 70-94years,mean age 78 years） were treated with radiotherapy alone. Prescription dose ranged 60 -66 Gy using standard fractionation. There were 38 patients （79.2 % ） with stage Ⅰ and 10 patients （20.8 % ） with stage Ⅱ lesion. Results Objective response rate was observed in 28（58.3 %） patients. The median survivaltime was 30.5 months,and 1 - 3 years survival rate was 56.3 %, 45.8 % and 39.6 % respectively. The median cause-specific survival time was 34.0 months,and 1 - 3 years cause-specific survival rate was 62.6 % ,53.0 % and 45.8 % respectively. Thirty patients dead including 16 （53.3 %） of inflammatory pneumonia,9 （30.0 %） of tumor wide spread, 3 （ 10.0 % ） of myocardial infarction, 1 （3.3 %） of alimentary tract hemorrhage, 1 （3.3 % ） of thyroid gland anaplastic carcinoma. Conclusion It is demonstrated that radiotherapy alone is effective with low toxicity in elderly patients with early stage non-small cell lung cancer. The treatment is benificial for these patients and the best choice for elderly patients who are intolerance or refusing to surgical treatment. According to the clinical analysis, the inflammatory pneumonia is the important cause for death.

关 键 词：非小细胞肺癌 放射疗法 老年 早期 

分 类 号：R734.2[医药卫生—肿瘤]