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）不同放疗剂量对生存的影响。方法2003-2010年共入组201例，可评价182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法并Logrank法检验，Cox回归模型多因素预后分析。结果201例随访率为97，5％，随访满〈1、1-2、1〉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；放疗剂量〈45．0Gy或45．0-62．1Gy以及≥63．0Gy的分别为20％、14％、0％和7．1个月或27％、10％、3％和9．6个月以及59％、22％、16％和14．9个月（X^2=27．88，P=0．000）；2-3个周期化疗同期放疗≥63Gy以及〈63Gy的分别为43％、19％、0％和11个月以及20％、11％、5％和8个月（X^2=2．99，P=0．084）；4-5个周期化疗同期放疗≥63Gy以及〈63Gy的分别为66％、23％、19％和16．0个月以及29％、12％、0％和8．8个月（X^2=15．87，P=0．000）；而2-3个周期化疗同期放疗≥63Gy和4-5个周期化疗同期放疗〈63Gy的生存差异无统计学意义（X^2=1．93，P=0．165）。多因素分析显示4-5个周期化疗同期放疗≥63Gy（p：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。结论Ⅳ期NSCLC的4-5个周期化疗同期胸内病灶三维放疗剂量≥63Gy时可能显著延长生存。
Objective To explore the effect of radiation dose on survival for stage IV non-small cell lung cancer （NSCLC） treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy （CCTI＇RT）. Methods From Jan. 2003 to Jul. 2010,201 Stage IV NSCLC patients were enrolled. Nineteen patients who received only one cycle chemotherapy were not included in survival analysis. Of the 182 patients eligible for survival analysis, all patients received platinum-based chemotherapy of two drugs. The median number of cycles was 4. The median dose to planning target volume of primary tumor （ DTgrv ） was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Lograuk. Cox regression models were used to examine the effect of DTrrv 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. The 1-,2-,3-year overall survival rate and median survival time was 20% , 14% ,0% and 7. 1 months ;27% , 10% ,3% and 9. 6 months; and 59% ,22% , 16% and 14. 9 months, respectively for patients treated with DTrrv 〈 45.0 Gy,45.0 - 62. 1 Gy and ≥63.0 Cry, respectively （ X^2 = 27.88,P = 0. 000） ;43%, 19% ,0% and 1 1 months and20% , 1 1% , 5 % and8months , respectively for those received2 - 3 cycles of chemotherapy and radiation dose 363 Gy and 〈 63 Gy, respectively （X^2 = 2. 99, P = 0. 084） ;66% , 23% , 19% and 16 months and 29%, 12%, 0% and 8.8 months, respectively for those received 4 - 5 cycles chemotherapy and radiation dose i〉 63 Gy and 〈 63 Gy, respectively （ X^2 = 15.87, P = 0. 000 ）. No significant difference was found for patients received 2 - 3 cycles chemotherapy concurrently with DTpTv 363 Gy and 4 -5 cycles chemotherapy concurrently with DTpTv 〈63 Gy, respectively （X2 = 1.93,P =0. 165）. Multivariate analysis showed that 4 - 5 cycles chemotherapy concurrently with DTptv≥163 Gy （ 13 = 0. 243, P = 0. 019）, and improved KPS after treatment （ 13 = 1. 268, P = 0. 000 ） were independent favorable factors for survival. Conclusion Chemotherapy concurrent with CCTTRT can prolong survival time of patients with stage Ⅳ NSCLC, especially for those treated with DTptv ≥63 Gv.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2012年第1期23-27,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
放疗剂量
预后
Carcinoma, non-small cell lung/concurrent chemoradiotherapy
Radiotherapy, three-dimensional
Radiotherapy dose
Prognosis
