经倾向评分匹配后立体定向放疗与手术治疗早期非小细胞肺癌预后比较  

Comparison of clinical prognosis between stereotactic body radiotherapy and surgical treatment for early-stage non-small cell lung cancer after propensity score matching

作　　者：董百强[1] 王谨[2] 徐裕金 狄小云[3] 单国平[3] 陈维军[3] 陈梦圆 郑雷 李浦 李剑龙 陈明 Dong Baiqiang;Wang Jin;Xu Yufin;Die Xiaoyun;Shan Guoping;Chen Weijun;Chen Mengyuan;Zheng Lei;Li Pu;Li Jianlong;Shao Kainan(Chen Ming Wenzhou Medical University,Wenzhou 325000,China;Department of Radiation Oncology;Department of Radiation Physics,3.Department of Oncology Surgery;Zhefiang Cancer Hospital,Hangzhou 310000,China;Zhejiang Key Laboratory of Radiation Oncology,Hangzhou 310000,China)

机构地区：[1]温州医科大学,325000 [2]浙江省肿瘤医院放疗科,杭州310000 [3]浙江省肿瘤医院放射物理室,杭州310000 [4]浙江省肿瘤医院胸外科,杭州310000 [5]浙江省放射肿瘤学重点实验室,杭州310000

出　　处：《中华放射肿瘤学杂志》2018年第10期890-894,共5页Chinese Journal of Radiation Oncology

摘　　要：目的评价立体定向放疗（SBRT）与手术治疗Ⅰ一Ⅱ期非小细胞肺癌患者的临床疗效。方法回顾分析2012-2015年在浙江省肿瘤医院经SBRT或手术的120例早期非小细胞肺癌患者，对两组进行倾向得分匹配，各纳入60例符合要求病例。放疔组80％等剂量线作为处方剂量覆盖95％PTV。100％等剂量线覆盖100％IGTV，每次5-15 Gy，中位生物等效剂量100 Gy（57．6-150．0Gy）；手术组VATS肺叶切除32例，楔形切除和肺段切除9例。结果两组患者均顺利完成治疗，随访率100％，中位随访时间32．3个月。3例手术患者90 d内因感染发生治疗相关死亡，SBRT组无治疗相关死亡（P=0．079）。SBRT组3例患者随访期间因肿瘤外因素死亡（脑梗死、心脏病等）。12例患者出现局部区域复发，其中手术组5例，SBRT组7例（P=0．543）。17例远处转移，其中手术组11例，SBRT组6例（P=0．835）。中位无瘤生存期手术组38．4个月，SBRT组33．5个月（P=0．178）；1、3年总生存率手术组分别为95％、83％，SBRT组分别为93％、83％（P=0．993）。结论SBRT对早期原发性NSCLC总生存期与手术相当，二者局部控制率相近。Objective To evaluate the clinical efficacy between stereotactic body radiotherapy （SBRT） and surgical treatment for stage I -I1 non-small cell lung cancer （NSCLC）. Methods Clinical data of 120 patients with early-stage NSCLC who underwent SBRT or surgical treatment in Zhejiang Cancer Hospital from 2012 to 2015 were retrospectively analyzed. Propensity score matching was carried out between two groups. Sixty eligible patients were enrolled in each group. In the SBRT group, the 80% isodose line covered 95% of the planning target volume, and the 100% isodose line covered 100% of the internal gross tumor volume. The fractional dose was 5-15 Gy and the median biologically equivalent dose was 100 Gy （range： 57.6-150.0 Gy）. In the operation group, 32 patients underwent video-assisted thoracoscopie lobectomy and 9 patients underwent wedge resection or segmenteetomy. Results All patients successfully completed corresponding treatment and were followed up. The median follow-up was 32.3 months （ range ： 8.6-68. 4 months）.In the operation group,3 patients died from infection within postoperative 90 d, whereas no case died in the SBRT group （ P= O. 079）. In the SBRT group, 3 patients died of other factors besides tumor （cerebral infarction, heart disease, etc.） during follow-up. Local-regional recurrence occurred in 12 patients including 5 eases in the operation group and 7 in the SBRT group （P= 0. 543 ）. In the operation group, 11 patients experienced distant metastases with a median disease-free survival （DFS） of 33.5 months. In the SBRT group, 6 patients had distant metastases and the median DFS was 38. 4 months （P= 0. 835 ,P= 0. 178 ）. In the SBRT group, the 1-and 3 -year overall survival rates were 93 % and 83 %, and 95 % and 83 % in the operation group （P= 0. 993）. Conclusions The 1-and 3-year overall survival rates and local control rate do not significantly differ between SBRT and operation for patients with early-stage NSCLC.

关 键 词：肺肿瘤/体部立体定向放射疗法 肺肿瘤/外科学 治疗结果 

分 类 号：R734.2[医药卫生—肿瘤]