非小细胞肺癌放疗总疗程时间对疗效的影响  

The impact Of overall treatment time on the results of radiation therapy for non－small cell lung cancer

作　　者：陈明[1] 傅小龙[1] 蒋国梁[1] 王丽娟[1] 钱浩[1] 赵森[1] 

机构地区：[1]上海医科大学肿瘤医院放疗科,上海200032

出　　处：《癌症》1999年第2期199-202,共4页Chinese Journal of Cancer

摘　　要：目的：回顾性分析根治性放疗的非小细胞肺癌（NSCLC）病例，探讨总疗程时间（OTT）对放疗效果的影响。材料与方法：选择1990年1月－1996年12月间根治性放疗的经病理确诊的Ⅰ－Ⅲb期NSCLC患者256例，生存统计采用Kaplan－Miers法及Log－rank检验，OTT与局控率关系采用线性回归分析，多因素分析采用Cox比例风险模型。结果：全组有45％（114／256）的患者发生疗程中断共137次，前两位原因为医源性耽搁和节假日休息，分别占55％和11％。全组1、3、5年局部控制率分别为54％、24％和19％；总疗程≤45天者分别为74％、35％和25％，总疗程＞45天者则分别为49％、17％和15％（P＜0．001）。103例BED＝80－85Gy患者线性回归显示疗程每延长1周，3年局控率下降9％。总疗程≤45天者与总疗程＞45天者相比，生存期延长，远处转移减少。多因素分析表明：总疗程时间对局控和生存均有显著性意义，对远处转移也有较高的危险度。结论：总疗程时间延长将导致NSCLC放疗疗效的降低。短疗程放疗方案应予提倡。应尽可能避免各种原因导致的疗程中断。Purpose : A retrospective analysis was camed out to evaluate the impact of overall treatment time (OTT) on the resulls Of radiation therapy for non－small cell lung cancer (NSCLC). Materials and Methods: From Jan. 1990 to Dec.1996, 256 Patients with stages Ⅰ－Ⅱ b NSCLC were eligible for the analysis. All patients received definitive radiotherapy.Analysis of the relationship between On and local control was carried out using Linear－regression. Multivariate analysis using Cox ProPOrtional hazards model were Performed to evaluate the significance of prognostic variables on local control, survival and distant metastasis. Results: OTT had been prolonged due to the treatment interruption in 45% (1 14/256) patients. The main causes of interruption were medical delay due to foe physicians and holiday rest Patients treated with prolonged Ors > 45 days) had significant POorer local control than that with Ors <45 days (P < 0. 0001 ). Linear－regression on 103 cases treated with BED of 80 －－ 85 Gy showed 3 year local control rate detfreased by 9% when ors prolonged for one week. Cox multivariate analyses coallrmed that OTT was an independent prognostic factor for local control and survival. Conclusion:PrDlonged treatment time adversely edict outcome of radiotherapy for NSCLC. Unconventional fractionated schedule with shortened on is warrant. Every effort should be made to keep lreatment on schedule, and intermptions for whatever reasons should be minimized.

关 键 词：非小细胞肺癌 放射疗法 总疗程时间 肺肿瘤 

分 类 号：R734.205[医药卫生—肿瘤] R730.55[医药卫生—临床医学]