器官和病灶联合定义寡转移Ⅳ期NSCLC原发灶三维根治剂量放疗的意义——PPRA—RTOG003再分析  

Significance of three-dimensional radical radiotherapy dose determined by organ-lesion combination for primary tumor of oligometastatic stage IV NSCLC ： a reanalysis of PPRA-RTOG 003

作　　者：王春兰[1] 苏胜发[2] 欧阳伟炜[2] 马筑[2] 李青松[2] 王羽[2] 粟蕙芹 卢冰[2] 

机构地区：[1]贵州医科大学肿瘤学教研室硕士研究生,550004 [2]贵州医科大学附属肿瘤医院贵州省肿瘤医院胸部肿瘤科

出　　处：《中华放射肿瘤学杂志》2016年第6期576-581,共6页Chinese Journal of Radiation Oncology

基　　金：基金项目：贵州省科技公关项目[SY[2010]3078];贵州省社发攻关资助项目[SY[2012]3097]

摘　　要：目的 分析器官和病灶联合定义寡转移Ⅳ期NSCLC原发灶3DRT剂量及其相关因素对生存的影响。方法 定义单器官和2个器官中每器官1个转移病灶为寡转移,共115例,分析剂量及相关因素与总生存的关系, Kaplan-Meier法计算生存并Logrank检验,Cox回归模型行多因素分析。结果 115例中位生存期（MST）为14个月,1、2、3年OS率分别为55.7%、18.3%、11.5%。原发灶剂量≥和〈63 Gy的OS比较,全组、2周期化疗获益、放化疗获益MST延长,分别为17个月和13个月（P=0.046）、17个月和13个月（P=0.037）、18个月和14个月（P=0.022）;转移灶放疗、原发灶有效有延长生存的趋势,MST均为17个月和13个月（P=0.055和P=0.065）;4~6周期化疗的MST为16个月和13个月（P=0.165）。放化疗有效、原发灶体积〈120.1 cm3、治疗后KPS改善比无效、大体积、KPS降低患者的MST延长（15个月比12个月,P=0.036;17个月和11个月,P=0.002;14个月和10个月,P=0.031）。多因素分析原发灶剂量和体积（P=0.020和P=0.001）、治疗后KPS变化（P=0.021）显著影响生存。结论 联合器官和病灶定义的寡转移Ⅳ期NSCLC化疗同期原发灶根治剂量放疗的生存期显著延长,原发灶体积、治疗后KPS是影响生存的独立预后因子。Objective To investigate the influence of three-dimensional radiotherapy dose determined by organ-lesion combination for the primary tumor of oligometastatic stage Ⅳ non-small cell lung cancer （NSCLC） and related factors on survival. Methods Oligometastasis was defined as the metastatic lesion in only one organ or 1 metastatic lesion in each of two organs. A total of 115 patients were enrolled,and the association of dose and related factors with overall survival was investigated. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis,and the Cox regression model was used for multivariate analysis. Results Of all patients,the median survival time （MST） was 14 months,and the 1-,2-,and 3-year overall survival （OS） rates were 55.7%,18.3%,and 11.5%,respectively. All the patients,the patients benefiting from two-cycle chemotherapy,and the patients benefiting from chemoradiotherapy showed prolonged MST,and in patients receiving a primary tumor dose of ≥63 Gy or〈63 Gy,the MST was 17 months and 13 months （P=0.046）,17 months and 13 months （P=0.037）,and 18 months and 14 months （P=0.022）,respectively. Radiotherapy for metastatic lesion and effective treatment for primary tumor tended to prolong survival time,and the MST was 17 months and 13 months,respectively （P=0.055 and 0.065）.The patients receiving 4-6 cycles of chemotherapy had an MST of 16 months and 13 months,respectively （P=0.165）.The patients who received effective chemoradiotherapy,had a primary tumor volume of〈120.1 cm3,and had improvement in Karnofsky Performance Scale （KPS） after treatment showed a prolonged MST compared with those who did not respond to chemoradiotherapy and had a large primary tumor volume and a reduction in KPS （15 months vs. 12 months,P=0.036;17 months vs. 11 months,P=0.002;14 months vs. 10 months,P=0.031）.The multivariate analysis showed that primary tumor dose and volume （P=0.020 and 0.001） and the change in KPS after t

关 键 词：癌 非小细胞肺 寡转移 同期化放疗法 放射疗法 三维 放疗剂量 预后 

分 类 号：R734.2[医药卫生—肿瘤]