伴恶性胸腔积液Ⅳ期NSCLC原发肿瘤三维放疗的临床分析  

Clinical outcome of radiotherapy for primary tumors in stageⅣnon-small cell lung cancer complicated with malignant pleural effusion

作　　者：韦天宇 马筑 陈霞霞 李晓阳 欧阳伟炜 苏胜发 李青松 耿一超 杨文刚 胡银祥 栗蕙芹 卢冰 Wei Tianyu;Ma Zhu;Chen Xiaxia;Li Xiaoyang;Ouyang Weiwei;Su Shengfa;Li Qingsong;Geng Yichao;Yang Wengang;Hu Yinxiang;Li Huiqin;Lu Bing(Department of Oncology,Guizhou Medical University/Department of Oncology,Affiliated Hospital of Guizhou Medical University/Guizhou Cancer Hospital,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院肿瘤科/贵州医科大学肿瘤学教研室/贵州省肿瘤医院肿瘤科,贵阳550004

出　　处：《中华放射肿瘤学杂志》2020年第7期523-528,共6页Chinese Journal of Radiation Oncology

基　　金：贵州省科技计划项目(黔科合支撑[2019]2795)。

摘　　要：目的回顾性探讨伴恶性胸腔积液Ⅳ期NSCLC原发灶三维放疗的有效性和安全性。方法选择2007-2018年经病理诊断、初诊的伴恶性胸腔积液Ⅳ期NSCLC198例,按治疗状况分为未治疗组45例、药物治疗组57例、放疗组96例。分析放疗组和药物组近期疗效、总生存和不良反应。Kaplan-Meier法计算生存率并log-rank检验,Cox模型多因素预后分析。结果放疗组有效率为54%、无效率为46%,显著优于药物组的25%、75%(P=0.007);1、2、3、5年总生存和中位生存期放疗组分别为47%、18%、6%、1%和12个月,显著高于药物组的15%、3%、2%、0%和5个月(P<0.001)。多因素分析显示增加原发灶放疗是延长生存的影响因素(P<0.001),≥63 Gy、4~6周期化疗有延长生存趋势(P=0.063、0.071),EGFR敏感突变者放疗联合分子靶向治疗总生存显著优于联合化疗而EGFR突变未知者(P=0.007)。增加原发灶放疗未增加明显的不良反应(P>0.05)。结论伴恶性胸腔积液Ⅳ期NSCLC原发灶三维放疗可能延长患者总生存,增加三维放疗的不良反应可耐受。Objective To retrospectively analyze the clinical efficacy and safety of three-dimensional radiotherapy for the primary tumors in patients with stageⅣnon-small cell lung cancer complicated with malignant pleural effusion(MPE-NSCLC).Methods A total of 198 patients who were initially pathologically diagnosed with MPE-NSCLC from January 2007 to April 2018 were enrolled and divided into the untreated group(n=45),drug group(n=57)and radiotherapy group(n=96),respectively.The short-term efficacy,overall survival(OS)and adverse events in the drug and radiotherapy groups were analyzed.The OS rate was analyzed by Kaplan-Meier method and log-rank test.Clinical prognosis was evaluated by multivariate Cox's regression model.Results In the radiotherapy group,the objective response rate and non-response rate was 54%and 46%,significantly better than 25%and 75%in the drug group(P=0.007).In the radiotherapy group,the 1-,2-,3-,5-year OS and median survival was 47%,18%,6%,1%and 12 months,remarkably higher than 15%,3%,2%,0%and 5 months in the drug group,respectively(all P<0.001).Multivariate Cox's regression analysis showed that radiotherapy for the primary tumors was an independent prognostic factor to prolong the OS(P<0.001).Radiotherapy at a dose of≥63Gy and 4-6 cycles of chemotherapy tended to prolong the OS(P=0.063 and 0.071).The OS of patients with EGFR mutation receiving radiotherapy combined with molecular target therapy was significantly better than that of those with unknown EGFR status treated with radiotherapy and chemotherapy(P=0.007).Addition of radiotherapy for the primary tumors did not significantly increase the incidence of adverse events(P>0.05).Conclusion Addition of three-dimensional radiotherapy for the primary tumors in MPE-NSCLC patients may prolong the OS and yield tolerable adverse events.

关 键 词：肺肿瘤/化学疗法 肺肿瘤/三维放射疗法 恶性胸腔积液 预后 

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