56例局部晚期非小细胞肺癌三维适形放疗加化疗的长期疗效分析  

Clinical analysis of three-dimensional conformal radiotherapy plus chemotherapy for locally advanced non-small cell lung cancer：study of 56 patients

作　　者：艾尼瓦尔·艾木都拉[1] 尚革[1] 包永星[1] 张莉[1] 

机构地区：[1]新疆医科大学第一附属医院肿瘤中心,乌鲁木齐830054

出　　处：《中华放射肿瘤学杂志》2011年第3期189-192,共4页Chinese Journal of Radiation Oncology

摘　　要：目的分析局部晚期非小细胞肺癌（NSCLC）三维适形放疗（3DCRT）疗效和不良反应，以及影响预后的因素。方法资料完整的56例Ⅲ期NSCLC患者纳入分析。其中男36例，女20例，年龄32～84岁。鳞癌28例，腺癌20例，腺鳞癌1例。ⅢA期32例，ⅢB期24例。单纯放疗14例，化放疗42例。放疗采用加速器6MVX线照射，1．8～3．0Gy／次，30—69Gy。化疗采用紫杉醇或多西紫杉醇或长春瑞滨＋顺铂或卡铂一线方案。结果随访率为96％，随访满3、5年者分别为14、10例。完全缓解5例，部分缓解34例，有效率为70％。1、3、5年生存率分别为62％、25％、17％，中位生存时间为20个月。Logrank检验显示临床分期、卡氏评分、肿瘤体积、放疗剂量、治疗模式、近期疗效显著影响生存率，Cox回归分析显示临床分期、治疗模式和近期疗效为独立预后因素。急性放射性肺炎2级1例、3级1例，晚期放射性肺炎2级1例、3级1例。急性放射性食管炎1级20例、≥2级5例。骨髓抑制1＋2级15例、〉2级4例。结论3DCRT治疗局部晚期NSCLC对临床分期较早、放疗剂量≥60Gy的化放疗、近期疗效好的患者生存率较好，放射性损伤在可接受范围。Objective To analyze the efficacy, complications and prognostic factors of threedimensional conformal radiotherapy （3DCRT） for locally advanced non-small cell lung cancer （NSCLC）. Methods 56 patients who were treated either by radiotherapy alone （14 patients） or radiotherapy plus chemotherapy （42 patients） from Jan. 2005 to Feb. 2008 were enrolled. The patient cohort consisted of 36 men and 20 women, median age 62, median total dose 60 Gy. Results The following-up rate was 96%. The number of patients completed follow-up were 14 and 10, respectively at 3-year and 5-year. The response rate of 3DCRT was 70%, with complete remission 9% and partial remission 61%. The 1-,3-,and 5-year survival rates were 62% ,25% and 17% ,respectively, and the median survival time （MST） was 20 months. By logrank test, clinical stage, KPS perfomance, tumor volume, radiation dose, treatment regimen and response to treatment showed statistically dramatic impact on overall survival. By Cox multivariable regression, the independent adverse prognostic factors by both univariate analysis and multivariate analysis were clinical stage, treatment type, and response to treatment. Grade 2 acute radiation pneumonitis was observed in 1 patient and grade 3 in 1 patient. Late grade 2 lung injury developed in 1 patient, and grade 3 in 1 patient. Acute grade 1 radiation esophagitis were observed in 20 patients, and above Grade 2 in 5 patients. Acute grade 1 ＋ 2 hematologic toxicity developed in 15 patients, and above Grade 2 developed in 4 patients. Conclusions 3DCRT was feasible in the treatment of locally advanced NSCLC with acceptable normal tissue toxicity. Relative early stage, radio-chemotherapy with total radiation dosage ≥60 Gy and good immediate tumor response are favorable prognostic factors for overall survival.

关 键 词：癌 非小细胞肺/放化疗法 放射疗法 三维适形 化学疗法 序贯 化学疗法  同期 预后 

分 类 号：R734.2[医药卫生—肿瘤]