田秀明; 邱嵘; 王玉祥; 葛晖; 李静; 祝淑钗; 乔学英

doi:10.3760/cma.j.issn.1004-4221.2016.07.004

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• 胸部肿瘤 •

Ⅲ期NSCLC的3DCRT长期疗效及预后因素

中华放射肿瘤学杂志, 2016,25(7) : 681-685. DOI: 10.3760/cma.j.issn.1004-4221.2016.07.004

摘要

目的

评价Ⅲ期NSCLC的3DCRT疗效以及预后相关因素。

方法

2000—2010年接受3DCRT的NSCLC患者474例，其中男382例、女92例，中位年龄63岁；Ⅲ_A期211例、Ⅲ_B期263例。单纯放疗165例、放疗＋化疗者309例；采用常规放疗＋3DCRT、3DCRT、IMRT者分别为55、340、79例，中位等效剂量60(44～77) Gy。Kapian-Meier法计算生存率，Logrank法单因素分析，Cox模型多因素分析。

结果

随访率96.6%；全组1、3、5年OS率分别为63.0%、24.9%、17.8%，中位生存期18个月。单因素分析显示性别、年龄、近期疗效、放疗方式、分割方式、化疗与否、RP为预后因素(P＝0.004、0.001、0.000、0.007、0.004、0.009、0.049)；多因素分析显示性别、年龄、近期疗效、放疗方式、RP为预后因素(P＝0.006、0.000、0.000、0.003、0.048)，其中放疗剂量60～66 Gy者预后最好。

结论

Ⅲ期NSCLC的3DCRT疗效表明女性、低年龄组、近期疗效好、全程3DCRT、0-1级RP者预后好，反之预后差；3DCRT联合化疗有生存获益，放疗剂量以60～66 Gy为宜。

引用本文: 田秀明, 邱嵘, 王玉祥, 等. Ⅲ期NSCLC的3DCRT长期疗效及预后因素 [J] . 中华放射肿瘤学杂志, 2016, 25(7) : 681-685. DOI: 10.3760/cma.j.issn.1004-4221.2016.07.004.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

3DCRT与常规放疗相比具有明显的剂量学优势^[1,2]，可获得更高生存率^[3,4,5]，目前已是肺癌治疗的主要技术。本研究回顾性分析2000—2010年474例放疗且资料完整的局部晚期NSCLC患者的临床资料，评价其长期疗效及预后因素。

贡献者信息

田秀明

050011　石家庄，河北医科大学第四医院放疗科；050011　石家庄，河北省胸科医院肿瘤内科

邱嵘

050011　石家庄，河北医科大学第四医院放疗科

王玉祥

050011　石家庄，河北医科大学第四医院放疗科

葛晖

050011　石家庄，河北医科大学第四医院呼吸科

李静

050011　石家庄，河北医科大学第四医院放疗科

祝淑钗

050011　石家庄，河北医科大学第四医院放疗科

乔学英

050011　石家庄，河北医科大学第四医院放疗科

通信作者

王玉祥

050011　石家庄，河北医科大学第四医院放疗科

Email：wyxhbs69@163.com

关键词

肺肿瘤/放射疗法; 放射疗法，二维; 放射疗法，三维; 预后;

基金项目

河北省医学科学研究重点课题（ZD20140300）

历史

出版日期：2016-07-15

收稿日期：2015-04-16

Thoracic Tumor

Prognosis and it related factors in patients of stage Ⅲ non-smallcell lung cancer after three-dimensional conformal radiotherapy

Xiuming Tian, Rong Qiu, Yuxiang Wang, Hui Ge, Jing Li, Shuhai Zhu, Xueying Qiao

Published 2016-07-15

Cite as Chin J Radiat Oncol, 2016, 25(7): 681-685. DOI: 10.3760/cma.j.issn.1004-4221.2016.07.004

Abstract

Objective

To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC).

Methods

From 2000 to 2010, 474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects. Those patients, consisting of 382 males and 92 females, had a median age of 63 years. In those patients, 211 had stage Ⅲ_A NSCLC and 263 had stage Ⅲ_B NSCLC; 165 were treated with radiotherapy alone and 309 with chemoradiotherapy; 55 were treated with conventional radiotherapy plus 3DCRT, 340 with 3DCRT, and 79 with intensity-modulated radiotherapy; the median equivalent dose was 60 Gy (44-77 Gy). The Kaplan-Meier method, log-rank test, and Cox model were used for survival rate calculation, univariate analysis, and multivariate analysis, respectively.

Results

The follow-up rate was 96.6%.In all patients, the 1-, 3-, and 5-year overall survival rates were 63.0%, 24.9%, and 17.8%, respectively; the median survival time was 18 months. The univariate analysis showed that sex, age, immediate response, radiotherapy method, fractionation scheme, chemotherapy, and radiation pneumonitis (RP) were prognostic factors (P=0.004, 0.001, 0.000, 0.007, 0.004, 0.009, 0.049). The multivariate analysis showed that sex, age, immediate response, radiotherapy method, and RP were independent prognostic factors (P=0.006, 0.000, 0.000, 0.003, 0.048). Patients with radiation doses of 60-66 Gy had the best prognosis of all.

Conclusions

In patients with stage Ⅲ NSCLC undergoing 3DCRT, female patients, patients at a young age, patients with satisfactory immediate response, patients treated with full-course 3DCRT, and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients. A radiation dose of 60-66 Gy is recommended.

Key words:

Lung neoplasms/radiotherapy; Radiotherapy, two-dimensional; Radiotherapy, three-dimensional; Prognosis

Contributor Information

Xiuming Tian