CAJ | 학술논문

目的前瞻性比较局部晚期非小细胞肺癌(LA-NSCLC)采用累及野照射(IFRT)或选择性淋巴结照射(ENI)局部失败的差异及对生存的影响.方法 99例LA-NSCLC经紫杉醇加卡铂化疗2周期后无远处转移患者随机分为IFRT组(45例)或ENI组(54例),IFRT组照射原发病灶、同侧肺门和纵隔阳性淋巴结,ENI组照射原发病灶、同侧肺门、双侧中上纵隔淋巴引流区及双侧锁骨上区.在满足双肺V20≤35％、脊髓受量≤50 Gy条件下给予尽可能高剂量,每周紫杉醇40mg/m2放疗增敏.采用Kaplan-Meier法计算生存率并Logrank法检验.结果随访率为99％,随访时间满1、2、3年者分别为49、29、17例.IFRT组与ENI组放疗剂量＞60 Gy的分别占49％和26％(x2=5.59,P=0.018),局部失败率分别为29％和36％(x2=0.46,P=0.497),1、2、3年局部无进展生存率分别为76％、69％、65％和80％、53％、49％(x2=0.74,P=0.389),1、3、5年总生存率分别为80％、41％、33％和69％、32％、13％(x2=3.97,P=0.046).两组不良反应相似(x2=3.91 ～0.16,P=0.142 ～0.925).结论 IFRT较ENI照射剂量高并增加了总生存率,未增加选择性照射区淋巴结复发率,不良反应相近,还需大样本研究.
목적 전첨성비교국부만기비소세포폐암(LA-NSCLC)채용루급야조사(IFRT)혹선택성림파결조사(ENI)국부실패적차이급대생존적영향.방법 99례LA-NSCLC경자삼순가잡박화료2주기후무원처전이환자수궤분위IFRT조(45례)혹ENI조(54례),IFRT조조사원발병조、동측폐문화종격양성림파결,ENI조조사원발병조、동측폐문、쌍측중상종격림파인류구급쌍측쇄골상구.재만족쌍폐V20≤35％、척수수량≤50 Gy조건하급여진가능고제량,매주자삼순40mg/m2방료증민.채용Kaplan-Meier법계산생존솔병Logrank법검험.결과 수방솔위99％,수방시간만1、2、3년자분별위49、29、17례.IFRT조여ENI조방료제량＞60 Gy적분별점49％화26％(x2=5.59,P=0.018),국부실패솔분별위29％화36％(x2=0.46,P=0.497),1、2、3년국부무진전생존솔분별위76％、69％、65％화80％、53％、49％(x2=0.74,P=0.389),1、3、5년총생존솔분별위80％、41％、33％화69％、32％、13％(x2=3.97,P=0.046).량조불량반응상사(x2=3.91 ～0.16,P=0.142 ～0.925).결론 IFRT교ENI조사제량고병증가료총생존솔,미증가선택성조사구림파결복발솔,불량반응상근,환수대양본연구.
Objective To evaluate the local failure and the impact on survival by prospectively comparing involved field radiotherapy (IFRT) and elective nodal irradiation (ENI) in combination with concurrent chemotherapy for locally advanced non-small cell lung cancer ( LA-NSCLC ).Methods LANSCLC patients were treated with 2 cycles of carboplatin ( AUC =5 - 6,d1 ) combined with paclitaxel ( 175mg/m2 ),followed assessment without distant metastasis,then randomized into IFRT (45 patients) or ENI (54 patients) arm.IFRT included primary tumor,ipsilateral hilar and positive mediastinal lymph nodes;ENI included the primary lesion,ipsilateral hilar,hilateral mediastinal lymph node drainage and bilateral supraclavicular area.The prescription dose was given as high as possible with V20 ≤35％ and spinal cord dose ≤50 Gy,combined weekly paclitaxel 40 mg/m2 concurrent chemotherapy.The Kaplan-Meier method was used to estimate survival data and the log-rank method was used to test distribution of survival time between arms.Results The follow-up rate was 99％.49,29 and 17 patients were followed-up for 1-,2-and 3-year,respectively.More patients from group IFRT received ＞60 Gy than ENI (49％ vs.26％,x2 =5.59,P =0.018 ).The local failure rates were 29％ and 36％,respectively ( x2 =0.46,P =0.497 ).The 1-,2-and 3-year local tumor progression-free survival rates were 76％,69％,65％ and 80％,53％,49％ ( x2 =0.74,P =0.389),respectively; the 1-,3-and 5-year overall survival rates were 80％,41％,33％ and 69％,32％,13％ (x2 =3.97,P =0.046),respectively.There were no significant differences in acute and late toxicities between the arms ( x2 =3.910 - 0.155,P =0.142 - 0.925 ).Conclusions IFRT improved radiation dose and survival rate and did not increase the failure of elective lymph node region compared with ENI.The toxicities were no differences between IFRT and ENL Further investigation with big size sample is warranted.