摘要
目的评价化疗同期胸部三维放疗Ⅳ期非小细胞肺癌（NSCLC）不同器官转移状态对生存的影响。方法2003--2010年共人组201例，可评价182例，其中单器官、多器官转移分别为107、75例。化疗以铂类为基础二药联合方案，中位周期数为4周期。胸内病灶中位计划靶体积剂量为63Gy。生存分析采用Kaplan-Meier法。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。182例1、2、3年生存率和中位生存期分别为41％、17％、10％和10．5个月；相似化放疗强度的单器官以及多器官转移分别为50％、20％、14％和13．0个月以及29％、12％、0％和8．5个月（χ2=10．10，P=0．001）；单纯骨及肺转移与多器官转移的分别为58％、25％、16％和14个月与29％、12％、0％和8个月（χ2=10．42，P=0．001）及49％、21％、21％和11个月与29％、12％、0％和8个月（χ2=6．39，P=0．011），单纯脑转移与多器官转移分别为49％、8％、0％和12个月与29％、12％、0％和8个月（χ2=0．71，P=0．401）；全组4～5个周期化疗同期放疗的单器官以及多器官转移分别为63％、23％、19％和15个月以及42％、15％、0％和10个月（χ2=6．47，P=0．011）；相同转移状态和4～5个周期化疗强度的单器官以及多器官转移放疗≥63Gy及〈63Gy的分别为71％、25％、25％和16．8个月及33％、17％、0％和10．5个月（χ2=4．73，P=0．030）以及54％、21％、0％和14．3个月及29％、10％、0％和7．6个月（χ2=8．16，P：0．004）。肝转移患者中位生存期为7个月，与除外肝转移的单器官、多器官转移比较有显著差异（χ2=17．21，P=0．000）。结论Ⅳ期NSCLC单器官转移在化疗同期应重视局部放疗，提高剂量延长生存期；肝转移预后较差。
Objective To prospectively evaluate the survival of different metastasis organs with concurrent chemotherapy and thoracic three-dimensional radiotherapy （CCTTRT） for stage Ⅳ non-small cell lung cancer （NSCLC）. Methods Two hundred and one patients of stage Ⅳ NSCLC were enrolled from January, 2003 to July, 2010. Of the 182 patients eligible for analysis, The number of patients with single- organ metastasis or multipleorgan metastasis was 107 and 75, respectively. Patients were treated by platinum-based chemotherapy, the median number of cycle was 4. The median dose to planning target volume of primary tumor （DTerv ） was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Logrank. 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. Of 182 patients, the 1-,2-, and 3-year overall survival （OS） rate and median survival time （MST） was 41.0%, 17.0%, 10. 0% and 10. 5 months, respectively;with single-organ metastasis and multi-organ metastasis were 50% ,20%, 14% and 13 months and 29% ,12% ,0% and 8.5 months （ χ2 = 10. 10, P = 0. 001 ）, respectively; compared with multi-organ metastasis, the 1-,2-, and 5-year OS arte and MST of patients with bone, lung metastasis only was 58%, 25% ,16% and 14 months （χ2 = 10.42,P =0. 001） and 49% ,21% ,21% and 11 months （χ2 =6. 39,P = 0. 011 ） respectively;patients with brain metastasis only did not show advantage of survival comparing with patients with multi-organ metastasis （49% ,8% ,0% and 12 months and 29% , 12% ,0% and 8 months, respectively ; χ2 = 0. 71 , P = 0. 401 ） ; the 1 -, 2-, and 3-year OS rate and MST was 63 % , 23% , 19% and 15 organ metastasis patients who accepted 4 - 5 cycles of chemotherapy （ χ2 = 6.47, P = 0. 011 ） ; for patients under the same metastasis and 4 - 5 cycles of chemotherapy, no matter whether single-organ or nmhiple- organ metastases, the 1-,2-,3-year OS rate and MST of patients with enough radiotherapy onDT_PTV ≥63 Gy were better than patients without enough radiotherapy （ DT_PTV 〈 63 Gy） （ 71% ,25% ,25 % and 16. 8 months and 33% ,17% ,0% and 10. 5 months,respectively;χ2 =4. 73 ,P =0. 030;54% ,21% ,0% and 14. 3 months and 29%, 10% ,0% and 7.6 months,respectively,χ2 = 8.16,P = 0. 004）. The MST of liver metastases was 6 months, there was significantly difference when comparing with non liver matastasis （χ2 = 17.21, P = 0. 000）, Conclusions It is very important to treat stage Ⅳ NSCLC with cCTrRT, especially patients with single-organ metastasis. Liver metastases is a unfavorable prognostic factor.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2011年第6期473-477,共5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[2010]2186]
关键词
癌
非小细胞肺/同期化放疗法
放射疗法
三维
转移器官
预后
Carcinoma, non-small cell lung）concurrent chemoradiotherapy
Radiotherapy,three-dimensional
Organ metastasis
Prognosis
