晚期非小细胞肺癌靶向治疗后失败模式及联合放疗临床意义  

Patterns of failure after targeted therapy and importance of combined radiotherapy for advanced non-small cell lung cancer

作　　者：武亚娟 赵军[2] 姜蕾蕾[1] 石安辉[1] 尤静[1] 朱广迎[1,4] Wu Yajuan;Zhao Jun;Jiang Leilei;Shi Anhui;You Jing;Zhu Guangying(Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education),Department of Radiation Oncology,Peking University Cancer Hospital &Institute,Beijing 100142,China;Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education),Department of Thoracic Oncology ,Peking University Cancer Hospital &Institute,Beijing 100142,China;Department of Radiation Oncology,Shanxi Cancer Hospital,Taiyuan 030013, China;Department of Radiation Oncology & Lung Cancer Center,Center of Respiratory Medicine,China-Japan Friendship Hospital,National Clinical Research Center for Respiratory Diseases,Beijing 100029,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科恶性肿瘤发病机制及转化研究教育部重点实验室,100036 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所胸部肿瘤内一科恶性肿瘤发病机制及转化研究教育部重点实验室,100036 [3]山西省肿瘤医院放疗胸部二病区,太原030013 [4]中日友好医院放射肿瘤科肺癌中心、中日友好医院呼吸中心国家呼吸疾病临床医学研究中心,北京100029

出　　处：《中华放射医学与防护杂志》2019年第2期113-120,共8页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的探讨晚期非小细胞肺癌患者经表皮生长因子酪氨酸激酶抑制剂(EGFR-TKIs)治疗后的失败模式及联合放疗的意义。方法分析北京大学肿瘤医院2009年1月至2013年6月接受EGFR-TKIs治疗的晚期伴EGFR外显子突变的非小细胞肺癌患者,采用Kaplan-Meier法分析不同失败模式及联合放疗对患者生存的影响。结果符合入组条件患者111例,中位年龄59岁(35~80岁),中位随访时间27.7个月(6.6~85.3个月),中位无进展生存(PFS)10.3个月(6.2~30.5个月),中位总生存(OS)29.8个月(7.1~90.7个月)。其中主要失败模式为原有病灶进展(65例,58.6%),主要失败部位为胸腔内病灶进展(57例,51.4%)。寡进展患者(耐药时病灶数目1~3个)与≥4个病灶进展者比较,生存期明显延长,中位OS分别为32.5、26.7个月,差异有统计学意义(χ^2=4.888,P<0.05)。仅胸腔内进展43例,放疗9例,未放疗34例,两组患者再治疗的中位PFS分别为9.6、5.7个月,联合放疗组明显延长,差异有统计学意义(χ^2=9.013,P<0.05);失败后再治疗的中位OS分别为28.1、13.2个月,两组间差异无统计学意义(P>0.05)。48例寡进展患者,放疗12例,未放疗36例,中位PFS分别为9.6、4.2个月,联合放疗组较未放疗组明显延长,差异有统计学意义(χ^2=5.482,P<0.05);失败后再治疗的中位OS分别为26.0、11.8个月,两组差异无统计学意义(P>0.05)。结论对于EGFR-TKIs治疗后仅胸腔内进展及寡进展的患者,联合局部放疗可以改善患者PFS。因此在1代EGFR-TKIs原发耐药的患者中,T790M突变阴性或没有条件进行相应检测的这部分患者,在出现胸腔内进展或寡进展时,进行局部干预是非常重要的。Objective To analyze clinical significance of failure patterns and combined radiotherapy for advanced non-small cell lung cancer after EGFR-TKIs treatment. Methods A total of 111 patients who were treated with EGFR-TKIs for advanced non-small cell lung cancer (NSCLC) with EGFR exon mutation in Peking University Cancer Hospital from January 2009 to June 2013 were retrospectively analyzed. The impact of various failure patterns and combined radiotherapy on survial were analyzed with Kaplan-Meier method. Results Totally 111 patients were enrolled in the study.The median follow-up was 27.7 months (6.6-85.3 months). The median age, median PFS andmedian OS were 59 years (35-80 years old), 10.3 months (6.2-30.5 months), and 29.8 months (7.1-90.7 months), respectively. The main failure mode was the progress of the original lesion (65 cases, 58.6%) and the main failure site was the progress of intrathoracic lesions (57 cases, 51.4%). The survival time of patients with oligo-progress (1-3 lesions during drug resistance) was significantly extended compared with the ones whose lesions were ≥4. The median OS were 32.5 months and 26.7 months, respectively (χ^2=4.888, P<0.05). For 43 patients with only intrathoracic progressed, there were 9 patients treated with radiotherapy and 34 patients treated without radiotherapy. The median PFS was 9.6 and 5.7 months, respectively. The median PFS of combined radiotherapy group was significantly prolonged (χ^2=9.013, P<0.05). And the median OS of retreatment after failure were 28.1 and 13.2 months, respectively, with no significant difference between two groups (P>0.05). For 48 patients with oligo-progress, there were 12 patients treated with radiotherapy and 36 patients treated without radiotherapy. The median PFS were 9.6 and 4.2 months, respectively. The median PFS of the group treated with combined radiotherapy was significantly longer than that of the group without combined radiotherapy treatment (χ^2=5.482, P<0.05). And the median OS of retreatment after failure were 26.0 and 1

关 键 词：非小细胞肺癌 靶向治疗 失败模式 放疗 

分 类 号：R734.2[医药卫生—肿瘤]