Ⅲ期NSCLC的3DCRT长期疗效及预后因素  

Prognosis and it related factors in patients of stage Ⅲ non-smallcell lung cancer after three- dimensional conformal radiotherapy

作　　者：田秀明[1,3] 邱嵘[1] 王玉祥[1] 葛晖[2] 李静[1] 祝淑钗[1] 乔学英[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]河北医科大学第四医院呼吸科,石家庄050011 [3]河北省胸科医院肿瘤内科,石家庄050011

出　　处：《中华放射肿瘤学杂志》2016年第7期681-685,共5页Chinese Journal of Radiation Oncology

基　　金：河北省医学科学研究重点课题（ZD20140300）

摘　　要：目的 评价Ⅲ期NSCLC的3DCRT疗效以及预后相关因素。方法 2000—2010年接受3DCRT的NSCLC患者474例,其中男382例、女92例,中位年龄63岁;ⅢA期211例、ⅢB期263例。单纯放疗165例、放疗＋化疗者309例;采用常规放疗＋3DCRT、3DCRT、IMRT者分别为55、340、79例,中位等效剂量60（44~77） Gy。Kapian-Meier法计算生存率,Logrank法单因素分析,Cox模型多因素分析。结果 随访率96.6%;全组1、3、5年OS率分别为63.0%、24.9%、17.8%,中位生存期18个月。单因素分析显示性别、年龄、近期疗效、放疗方式、分割方式、化疗与否、RP为预后因素（P=0.004、0.001、0.000、0.007、0.004、0.009、0.049）;多因素分析显示性别、年龄、近期疗效、放疗方式、RP为预后因素（P=0.006、0.000、0.000、0.003、0.048）,其中放疗剂量60~66 Gy者预后最好。结论 Ⅲ期NSCLC的3DCRT疗效表明女性、低年龄组、近期疗效好、全程3DCRT、0-1级RP者预后好,反之预后差;3DCRT联合化疗有生存获益,放疗剂量以60~66 Gy为宜。Objective To evaluate the efficacy of three-dimensional conformal radiotherapy （3DCRT） and prognostic factors for stage Ⅲ non-small cell lung cancer （NSCLC）. Methods From 2000 to 2010, 474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects. Those patients, consisting of 382 males and 92 females, had a median age of 63 years. In those patients, 211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT, 340 with 3DCRT, and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy （44-77 Gy）.The Kaplan-Meier method, log-rank test, and Cox model were used for survival rate calculation, univariate analysis, and multivariate analysis, respectively. Results The follow-up rate was 96.6%.In all patients, the 1-, 3-, and 5-year overall survival rates were 63.0%, 24.9%, and 17.8%, respectively;the median survival time was 18 months. The univariate analysis showed that sex, age, immediate response, radiotherapy method, fractionation scheme, chemotherapy, and radiation pneumonitis （RP） were prognostic factors （P=0.004,0.001,0.000,0.007,0.004,0.009,0.049）.The multivariate analysis showed that sex, age, immediate response, radiotherapy method, and RP were independent prognostic factors （P=0.006,0.000,0.000,0.003,0.048）.Patients with radiation doses of 60-66 Gy had the best prognosis of all. Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT, female patients, patients at a young age, patients with satisfactory immediate response, patients treated with full-course 3DCRT, and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients. A radiation dose of 60-66 Gy is recommended.

关 键 词：肺肿瘤/放射疗法 放射疗法 二维 放射疗法 三维 预后 

分 类 号：R734.2[医药卫生—肿瘤] R730.55[医药卫生—临床医学]