非小细胞肺癌根治术后残端复发的放射治疗  

Radiotherapy of stump recurrence in nonsmall cell lung cancer with radical operation

作　　者：冯勤富[1] 汪楣[1] 杨宗贻[1] 张志贤[1] 苗延浚[1] 殷蔚伯[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院

出　　处：《中华放射肿瘤学杂志》1998年第3期152-155,共4页Chinese Journal of Radiation Oncology

摘　　要：目的评价和分析非小细胞肺癌根治术后残端复发的放射治疗疗效及预后因素。材料与方法从１９７０年２月至１９９３年初，３９例肺癌根治术后残端复发的病人入组分析。中位年龄５９岁，术后至复发时间３～５０月，始发复发症状至确诊时间０～２０月。伴有淋巴结转移者１８例，残端复发有组织学诊断２８例。８例加腔内放疗８～３０Ｇｙ／１～３次，２例加化疗，６例单纯腔内放疗１２～３０Ｇｙ／２～３次。单纯外照射剂量为４５～７０Ｇｙ，加腔内放疗者为２０～６０Ｇｙ。结果症状缓解率达９０％左右，５年生存率２３．０±７．５％。单纯残端复发者５年生存率３８．１±１１．０％，而伴有淋巴结转移者无３年存活（Ｐ＜０．００３）。始发复发症状至确诊时间＜２月与≥２月者，５年生存率分别为３３．７±１２．０％与１２．６±８．２％（Ｐ＞０．１０４５）。在６例行单纯腔内放疗中，２例长期生存。Ｃｏｘ回归分析仅残端复发是否伴有淋巴结转移为影响预后的重要因素。结论放射治疗是治疗非小细胞肺癌根治术后残端复发的重要手段。Purpose To evaluate the effect of radiotherapy and the prognosis factors of stump recurrence in nonsmall cell lung cancer(NSCLC) after radical operation.Materials and Methods From Feb,1970 to Jan, 1993,39 patients of stump recurrence in NSCLC with radical operation were irradiated.The period between operation and stump recurrence and the interval from the first symptom of recurrence to diagnosis were 3～50 months and 0～20 months, respectively. Eighteen patients had stump recurrence with lymph node metastasis and 28 patients were confirmed by histopathology. Brachytherapy (8～30Gy/1～3f) was added in 6 patients, chemotherapy in 2 patients and brachytherapy alone (12Gy～30Gy/2～3f) 6 patients. The doses of external irradiation alone were 45～70Gy ,20～60Gy with brachytherapy.Results Symptom relief rate was 90%.The overall actuarial 5year survival rate was 23.0±7.5% . There was improved survival in patients with stump recurrence alone with the 5year survival rate of 38.1±11.0% ,but no patient survived over 3 years if they had stump recurrence and lymph node metastasis (P<0.03). There was also a trend toward improving survival in patients with the diagnosis made in <2 months after the symtom present with 5year survival rate of 33.7±12.0% vs 12.6±8.2% in those ≥2 months (P>0.145). Two of six patients had longterm survival with brachytherapy alone. Cox proportional analysis showed that patients of recurrence with or without lymph node metastasis was the main factor affecting radiotherapy effect.Conclusion Radiotherapy is a good treatment for patients with stump recurrence in NSCLC after radical operation ,especially for stump recurrence alone patients.

关 键 词：肺癌 放射疗法 非小细胞肺癌 复发 术后 

分 类 号：R734.205[医药卫生—肿瘤]