摘要
目的研究Ⅳ期非小细胞肺癌（NSCLC）化疗同期胸内病灶三维放疗的疗效和安全性。方法2003-2010年共入组201例，可疗效分析182例，安全性分析201例。化疗以铂类为基础二药联合方案，中位周期数为4个。胸内病灶中位计划靶体积剂量为63Gy。分析患者的生存情况，胃肠道、血液学不良反应，放射性肺炎和食管炎。用Kaplan-Meier法进行生存分析，Cox回归模型进行多因素分析。结果201例的随访率为97．5％，随访满〈1、1-2、≥3年者分别为201、170、134例。全组182例中4-5个周期化疗同期三维放疗和同期三维放疗≥63Gy的1、2、3年生存率以及中位生存期（MST）分别为54％和66％、20％和23％、13％和19％以及14．3个月和16．1个月；相似放化疗强度下单器官和多器官转移的MST分别为13．0个月和8．5个月（χ2=10．10，P=0．001）；同期放疗1〉63Gy和〈63Gy的MST在全组、4～5个周期化疗的分别为lg．9个月和8．4个月（χ2 =20．48，P=0．000）、16．1个月和8．8个月（χ2=11．75，P=0．001），单器官、多器官的分别为16．0个月和9．0个月（χ2=10．51，P=0．001）、11．0个月和7．0个月（χ2=7．90，P=0．005）。多因素分析显示4—5个周期化疗同期放疗≥63Gy（β=0．243，P=0．019）、治疗后卡氏评分变化（β=1．268，P=0．000）对生存有影响。201例患者的2＋3级胃肠反应发生率为45．0％；3＋4级白细胞、血小板、血红蛋白不良反应发生率分别为35．0％、18．0％、15．0％；2＋3级放射性肺炎和食管炎发生率分别为9．5％和13．4％。结论Ⅳ期NSCLC化疗同期原发灶高剂量三维放疗可能使生存期延长，不良反应可接受。
Objective To evaluate the overall survival and safety among patients for stage Ⅳ non- small cell lung cancer （NSCLC） treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy （CCTTRT）. Methods From Jan. 2003 to July 2010, 201 patients with stage IV NSCLC were included. All patients were treated with CCTFRT. Those patients who received only one cycle chemotherapy were not included in survival analysis, but analysis of toxicity. One hundred and eighty-two patients were eligible for survival analysis. All patients received platinum-based two-drug chemotherapy. The median number of cycles was 4. The median dose to planning target volume of primary tumor （ DT_PTV ） was 63 Gy. Treatment-related gastrointestinal and hematological toxicity were scored according to WHO criteria. Radiation-related pneumonitis and esophagitis were evaluated according to the National Cancer Institute＇s Common Terminology Criteria for Adverse Events （CTC） version 3.0. Survival was calculated by Kaplan- Meier method and compared using the Logrank. Cox regression model was used to examine the effect of CCTTRT on overall survival. Results The follow-up rate of 201 patients was 97.5%. with 201,170 and 134 patients finished 〈 1, 1 - 2 and ≥3 years＇ follow-up, respectively. Of the 182 patients eligible for survival analysis, further stratified analysis showed that the 1-, 2-and 3-year overall survival rate and median survival time （MST） was 54% , 20% , 13% and 14. 3 months, respectively for patients treated with concurrent 4 -5 cycles chemotherapy and CCTTRT, and 66% ,23%, 19% and 16. 1 months, respectively for those treated with 4 - 5 cycles chemotherapy and DT_PTV ≥63 Gy. Under similar ehemoradiotherapy intensity, the MST of patients with single organ metastasis was significantly longer than that with muhiple organ metastases （ 13.0 months versus 8.5 months, ~2 = 10. 10, P = 0. 001 ）. For patients eligible for survival analysis and received 4 - 5 cycles of systemic chemotherapy, MST of patients treated with DT_PTV 〉 63 Gy was significantly longer than those treated with DT_PTV 〈 63 Gy [ 14. 9 months vs. 8.4 months （ χ2= 20.48,P =0. 000） and 16. 1 months vs. 8. 8 months （χ2= 11.75,P =0. 001 ） 1. For patients with single organ metastasis, MST was 16 months for those treated with DT_PTV≥63 Gy and 9 months for those with DT_PTV 〈 63 Gy （χ2= 10. 51, P = 0. 000） ;for patients with multiple organ metastasis, it was 11 months and 7 months, respectively （ χ2 = 7.90, P = 0. 005 ）. Multivariate analysis showed that concurrent 4 - 5 cycles chemotherapy and DT_PTV≥63 Gy （ β = 0. 243, P = 0. 019） and improved KPS （ β= 1. 268, P = 0. 000） were independent factors for survival. For the whole group, 45% patients had Grade 2 -3 gastrointestinal toxicity,35.0% grade 3 -4 leukopenia, 18% grade 3 -4 thrombocytopenia. 15.0% grade 3 -4 anemia, 9. 5% Grade 2 - 3 radiation pneumonia and 13.4% radiation esophagitis, respectively. Conclusions For stage 1W NSCLC, CCTFRT can prolong survival time with acceptable toxicity. Radiotherapy to thoracic primary tumor should be under consideration.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2011年第6期467-472,共6页
Chinese Journal of Radiation Oncology
基金
贵州省科技公关项目[SY[2010]3078]
贵州省科学技术自然基金项目[J[201032186]
关键词
癌
非小细胞肺/同期化放疗法
放射疗法
三维
预后
不良反应
Carcinoma, non-small cell lung/concurrent chemoradiotherapy
Radiotherapy,three-dimensional
Prognosis
Toxicity
