中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2011年
6期
473-477
,共5页
王刚%卢冰%苏胜发%欧阳伟炜%胡银祥%龙金华%栗蕙芹%张波
王剛%盧冰%囌勝髮%歐暘偉煒%鬍銀祥%龍金華%慄蕙芹%張波
왕강%로빙%소성발%구양위위%호은상%룡금화%률혜근%장파
癌,非小细胞肺/同期化放疗法%放射疗法,三维%转移器官%预后
癌,非小細胞肺/同期化放療法%放射療法,三維%轉移器官%預後
암,비소세포폐/동기화방요법%방사요법,삼유%전이기관%예후
Carcinoma,non-small cell lung/concurrent chemoradiotherapy%Radiotherapy,three-dimensional%Organ metastasis%Prognosis
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年共入组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63 Gy.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(x2=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(x2=10.42,P=0.001)及49％、21％、21％和11个月与29％、12％、0％和8个月(x2=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(x2 =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(x2 =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≥63 Gy及＜63 Gy的分别为71％、25％、25％和16.8个月及33％、17％、0％和10.5个月(x2=4.73,P=0.030)以及54％、21％、0％和14.3个月及29％、10％、0％和7.6个月(x2 =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(x2=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.
目的 評價化療同期胸部三維放療Ⅳ期非小細胞肺癌(NSCLC)不同器官轉移狀態對生存的影響.方法 2003-2010年共入組201例,可評價182例,其中單器官、多器官轉移分彆為107、75例.化療以鉑類為基礎二藥聯閤方案,中位週期數為4週期.胸內病竈中位計劃靶體積劑量為63 Gy.生存分析採用Kaplan-Meier法.結果 201例的隨訪率為97.5％,隨訪滿＜1、1～2、≥3年者分彆為201、170、134例.182例1、2、3年生存率和中位生存期分彆為41％、17％、10％和10.5箇月；相似化放療彊度的單器官以及多器官轉移分彆為50％、20％、14％和13.0箇月以及29％、12％、0％和8.5箇月(x2=10.10,P=0.001)；單純骨及肺轉移與多器官轉移的分彆為58％、25％、16％和14箇月與29％、12％、0％和8箇月(x2=10.42,P=0.001)及49％、21％、21％和11箇月與29％、12％、0％和8箇月(x2=6.39,P=0.011),單純腦轉移與多器官轉移分彆為49％、8％、0％和12箇月與29％、12％、0％和8箇月(x2 =0.71,P=0.401)；全組4～5箇週期化療同期放療的單器官以及多器官轉移分彆為63％、23％、19％和15箇月以及42％、15％、0％和10箇月(x2 =6.47,P=0.011)；相同轉移狀態和4～5箇週期化療彊度的單器官以及多器官轉移放療≥63 Gy及＜63 Gy的分彆為71％、25％、25％和16.8箇月及33％、17％、0％和10.5箇月(x2=4.73,P=0.030)以及54％、21％、0％和14.3箇月及29％、10％、0％和7.6箇月(x2 =8.16,P=0.004).肝轉移患者中位生存期為7箇月,與除外肝轉移的單器官、多器官轉移比較有顯著差異(x2=17.21,P=0.000).結論 Ⅳ期NSCLC單器官轉移在化療同期應重視跼部放療,提高劑量延長生存期；肝轉移預後較差.
목적 평개화료동기흉부삼유방료Ⅳ기비소세포폐암(NSCLC)불동기관전이상태대생존적영향.방법 2003-2010년공입조201례,가평개182례,기중단기관、다기관전이분별위107、75례.화료이박류위기출이약연합방안,중위주기수위4주기.흉내병조중위계화파체적제량위63 Gy.생존분석채용Kaplan-Meier법.결과 201례적수방솔위97.5％,수방만＜1、1～2、≥3년자분별위201、170、134례.182례1、2、3년생존솔화중위생존기분별위41％、17％、10％화10.5개월；상사화방료강도적단기관이급다기관전이분별위50％、20％、14％화13.0개월이급29％、12％、0％화8.5개월(x2=10.10,P=0.001)；단순골급폐전이여다기관전이적분별위58％、25％、16％화14개월여29％、12％、0％화8개월(x2=10.42,P=0.001)급49％、21％、21％화11개월여29％、12％、0％화8개월(x2=6.39,P=0.011),단순뇌전이여다기관전이분별위49％、8％、0％화12개월여29％、12％、0％화8개월(x2 =0.71,P=0.401)；전조4～5개주기화료동기방료적단기관이급다기관전이분별위63％、23％、19％화15개월이급42％、15％、0％화10개월(x2 =6.47,P=0.011)；상동전이상태화4～5개주기화료강도적단기관이급다기관전이방료≥63 Gy급＜63 Gy적분별위71％、25％、25％화16.8개월급33％、17％、0％화10.5개월(x2=4.73,P=0.030)이급54％、21％、0％화14.3개월급29％、10％、0％화7.6개월(x2 =8.16,P=0.004).간전이환자중위생존기위7개월,여제외간전이적단기관、다기관전이비교유현저차이(x2=17.21,P=0.000).결론 Ⅳ기NSCLC단기관전이재화료동기응중시국부방료,제고제량연장생존기；간전이예후교차.
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 multiple-organ 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 (DTPTv) 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 ( x2 =10.10,P =0.001 ),respectively; compared with multi-organ metastasis,the 1-,2-,and 3-year OS arte and MST of patients with bone,lung metastasis only was 58％,25％,16％ and 14 months (x2 =10.42,P=0.001 ) and 49％,21％,21％ and 11 months (x2 =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;x2 =0.71,P =0.401 ) ;the 1-,2-,and 3-year OS rate and MST was 63％,23％,19％ and 15 months and 42％,15％,0％ and 10 months,respectively for patients with single-organ metastasis and multi-organ metastasis patients who accepted 4 - 5 cycles of chemotherapy ( x2 =6.47,P =0.011 ) ; for patients under the same metastasis and 4 - 5 cycles of chemotherapy,no matter whether single-organ or multiple-organ metastases,the 1 -,2-,3-year OS rate and MST of patients with enough radiotherapy on DTPTV ≥63 Gy were better than patients without enough radiotherapy ( DTPTV ＜ 63 Gy ) ( 71％,25 ％,25％ and 16.8 months and 33％,17％,0％ and 10.5 months,respectively;x2 ＝4.73,P =0.030 ;54％,21％,0％ and 14.3 months and 29％,10％,0％ and 7.6 months,respectively,x2 =8.16,P =0.004).The MST of liver metastases was 6 months,there was significantly difference when comparing with non liver matastasis ( x2 =17.21,P =0.000).Conclusions It is very important to treat stage Ⅳ NSCLC with CCTTRT,especially patients with single-organ metastasis.Liver metastases is a unfavorable prognostic factor.
