摘要
目的：探讨基于全身化疗的基础上胸部原发病灶三维放疗在Ⅳ期非小细胞肺癌综合治疗中的作用.方法：2003年1月至2010年7月93例Ⅳ期NSCLC患者接受至少4周期化疗并同期胸部原发病灶三维放疗≥40Gy,对疗效及预后因素进行分析,Kaplan-Meier法计算生存率并行Logrank检验,Cox回归模型行多因素预后分析.结果：末次随访日期2013年3月,中位随访14.0个月（4.0个月～80.0个月）；截止末次随访有5例患者存活,生存时间34.0个月～ 80.0个月,中位生存时间64.0个月.全组中位生存期为14.0个月（95％ CI,11.44-16.60）,1年、2年、3年生存率分别为54.8％、20.4％和12.9％.61例知道确切死亡原因,48例患者死于远处转移,7例死亡时局部复发伴有远处转移,仅2例死亡时单纯局部复发.胸部原发灶放疗处方剂量≥63 Gy和＜63Gy的中位生存期分别为15.0个月（95％ CI,12.86～17.14）和8.0个月（95％ CI,5.89-10.11）（x2=10.416,P=0.001）；单器官转移患者生存期比多器官转移患者长,MST为15.0个月（95％ CI,12.25-17.75）比10.0个月（95％ CI,6.04-13.96） （x2＝9.436,P =0.002）.亚组分析,单器官转移患者DTpTv≥63 Gy仍是影响生存的因素（x2＝4.733,P＝0.030）;多器官转移患者DTpTv≥63Gy有延长总生存的趋势（x2=3.488,P=0.062）.多因素分析显示：胸部原发肿瘤（DTpTv）≥63Gy和单器官转移是影响总生存期的独立预后因素.结论：全身系统化疗的基础上,胸部原发病灶积极的放射治疗（≥63Gy）能使患者生存获益,单器官转移患者从该治疗模式中获益较大,多器官转移患者也有生存获益的趋势,积极的放射治疗可能在改善生存方面具有重要作用.
Objective： To investigate the therapettic effect of thoracic three-dimensional radiotherapy in combination with sys- temic chemotherapy in patients with stage IV non-small-cell lung cancer （NSCLC）. Methods： We analyzed the therapeutic efficacies and prognostic factors for 93 cases of patients with stage IV NSCLC who received at least four cycles of chemotherapy in combination with concurrent thoracic three-dimensional radiotherapy of t〉40 Gy on primary tumors from January 2003 to July 2010. The Kaplan Meier method was used to calculate the OS. The log-rank test was used to compare the survival curves. Multivariate cox regression ana- lyses were used to test independent significant prognostic factors for OS. Results： The last follow-up date was March 2013, the median survival time （MST） was 14. 0 months, and the 1, 2, and 3-year survival rates was 54. 8%, 20. 4% , and 12.9% , respectively. At the last follow up, 5 patients were still alive, MST was 64. 0 months （ range, 34 - 80）. The MST of the patients received thoracic radiation dose of I〉63 Gy and 〈 63 Gy for the primary tumor were 15.0 and 8.0 months, respectively （ X2 = 10. 416, P =0. 001 ）. The MST of patients with metastasis to a single organ were longer than that of patients with metastasis to multiple organs （ 15.0 months vs. 10.0 months） （X2 = 9.436, P = 0. 002）. In a sub- group analysis of the patients with metastasis to a single organ, thoracic radiation dose 〉/63 Gy remained a prognostic factor for survival （ X2 = 4. 733, P = 0. 030） ; in the patients with metastases in multiple organs, radiation dose 1〉63 Gy had a trend to improve overall survival （~2 = 3. 488, P =0. 062）. A multivariate a- nalysis showed that radiation dose /〉63 Gy on the primary tumor and metastasis to a single organ were associated with better overall sur- vival time. Conclusion： In combination with systemic chemotherapy, radiation dose I〉63 Gy on the primary tumor and metastasis to a single organ are significant factors for better overall survival. Aggressive radiotherapy may improve survival of a subset of such patients with stage IV NSCLC.
出处
《肿瘤预防与治疗》
2013年第4期196-200,共5页
Journal of Cancer Control And Treatment
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
非小细胞肺癌
Ⅳ期
放射疗法
三维
预后
Non-small Cell Lung Cancer
Stage IV
Radiotherapy
Three-dimensional
Prognosis
