7O岁及以上老年人Ⅲ期非小细胞肺癌三维适形放疗的预后因素  

Prognostic factors of three-dimensional conformal radiotherapy for stage Ⅲ non-small cell lung cancer patients aged 70 and over

作　　者：田秀明[1] 王玉祥[1] 邱嵘[1] 葛晖[2] 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

出　　处：《中华老年医学杂志》2017年第9期970-974,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年Ⅲ期非小细胞肺癌（NSCLC）患者三维适形放疗的疗效及预后影响因素。方法回顾性分析124例≥70岁行根治性三维适形放疗的Ⅲ期NSCLC患者资料，其中男99例、女25例；中位年龄75岁（70～84岁）；中位处方剂量60Gy（50～72Gy）；83例单纯放疗、序贯放化疗27例、同期放化疗14例。结果随访至2013年10月，全组放疗后1、3、5年生存率和中位生存期分别为61．1％、23．8％、13．2％和18个月。单因素分析显示，性别、阻塞性肺炎、处方剂量、治疗方法和近期疗效与预后生存有关（χ^2=3．957、6．398、7．147、12．307、11．035，P=0．047、0．011、0．008、0．002、0．001）；多因素分析显示，性别、年龄、阻塞性肺炎、处方剂量和治疗方法为独立预后因素。年龄≥75岁、女性、无阻塞性肺炎、处方剂量≥60Gy者生存率高，反之生存率低；与单纯放疗相比，序贯放化疗提高生存率，同期放化疗降低生存率。结论性别、年龄、阻塞性肺炎和处方剂量均影响老年人Ⅲ期NSCLC三维适形放疗后生存，但同期放化疗须谨慎。Objective To assess the therapeutic efficacy and prognostic factors in elderly patients with stage Ⅲ non-small cell lung cancer （NSCLC） after three-dimensional conformal radiotherapy （3DCRT）. Methods A retrospective analysis of 124 stage Ⅲ NSCLC patients aged 70 or over who had received treatment with 3DCRT was conducted retrospectively in this study. There were 99 male and 25 female patients, with a median age of 74 years （range： 70-84）. The median dose was 60 Gy（range 50-72 Gy）. Eighty-three patients were treated with radiotherapy alone, 27 with sequential and 14 with concurrent radiochemotherapy. Results The end date of follow up was August 30, 2013. After 3DCRT, the 1-, 3-and 5-year overall survival （OS） were 61.1%, 23.8% andl3.2%, respectively,and the median survival time was 18 months. Univariate analysis revealed that gender,obstructive pneumonia, dosage,method of therapy and immediate effect were related to OS（χ^2=3. 957,6. 398,7. 147,12. 307 and 11. 035,respectively;P=0. 047,0. 011,0. 008,0. 002 and 0. 001, respectively）. Multi-variable analysis indicated that age, gender, obstructive pneumonia, dosage and method of therapy were independent prognostic factors for OS. The OS time was longer inpatients who were female, aged over 75, with no obstructive pneumonia or dosage≥ 60 Gy. Compared with radiotherapy alone, sequential radiochemotherapy increased OS while concurrent radiochemotherapy decreased OS. Conclusions Sex,age,obstructive pneumonia and dosage affect the survival of elderly stage Ⅲ NSCLC patients treated with three-dimensional conformal radiotherapy. Concurrent radiochemotherapy should be considered with caution

关 键 词：癌 非小细胞肺 放射疗法 计算机辅助 预后 

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