中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2012年
1期
23-27
,共5页
龙金华%卢冰%欧阳伟炜%苏胜发%胡银祥%王刚%栗惠芹%陈潇潇%龚修云%张波
龍金華%盧冰%歐暘偉煒%囌勝髮%鬍銀祥%王剛%慄惠芹%陳瀟瀟%龔脩雲%張波
룡금화%로빙%구양위위%소성발%호은상%왕강%률혜근%진소소%공수운%장파
癌,非小细胞肺/同期化放疗法%放射疗法,三维%放疗剂量%预后
癌,非小細胞肺/同期化放療法%放射療法,三維%放療劑量%預後
암,비소세포폐/동기화방요법%방사요법,삼유%방료제량%예후
Carcinoma,non-small cell lung/concurrent chemoradiotherapy%Radiotherapy,three-dimensional%Radiotherapy dose%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63 Gy.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、≥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＜45.0 Gy或45.0～62.1 Gy以及≥63.0 Gy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(χ2=27.88,P=0.000)；2～3个周期化疗同期放疗≥63 Gy以及＜63 Gy的分别为43％、19％、0％和11个月以及20％、11％、5％和8个月(χ2=2.99,P=0.084)；4～5个周期化疗同期放疗≥63 Gy以及＜63 Gy的分别为66％、23％、19％和16.0个月以及29％、12％、0％和8.8个月(χ2=15.87,P=0.000)；而2～3个周期化疗同期放疗≥63 Gy和4～5个周期化疗同期放疗＜63 Gy的生存差异无统计学意义(χ2=1.93,P=0.165).多因素分析显示4～5个周期化疗同期放疗≥63 Gy(β=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≥63 Gy时可能显著延长生存.
目的 評價化療同期胸部三維放療Ⅳ期非小細胞肺癌(NSCLC)不同放療劑量對生存的影響.方法 2003-2010年共入組201例,可評價182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法併Logrank 法檢驗,Cox迴歸模型多因素預後分析.結果 201例隨訪率為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；放療劑量＜45.0 Gy或45.0～62.1 Gy以及≥63.0 Gy的分彆為20％、14％、0％和7.1箇月或27％、10％、3％和9.6箇月以及59％、22％、16％和14.9箇月(χ2=27.88,P=0.000)；2～3箇週期化療同期放療≥63 Gy以及＜63 Gy的分彆為43％、19％、0％和11箇月以及20％、11％、5％和8箇月(χ2=2.99,P=0.084)；4～5箇週期化療同期放療≥63 Gy以及＜63 Gy的分彆為66％、23％、19％和16.0箇月以及29％、12％、0％和8.8箇月(χ2=15.87,P=0.000)；而2～3箇週期化療同期放療≥63 Gy和4～5箇週期化療同期放療＜63 Gy的生存差異無統計學意義(χ2=1.93,P=0.165).多因素分析顯示4～5箇週期化療同期放療≥63 Gy(β=0.243,P=0.019)、治療後卡氏評分變化(β=1.268,p=0.000)對生存有影響.結論 Ⅳ期NSCLC的4～5箇週期化療同期胸內病竈三維放療劑量≥63 Gy時可能顯著延長生存.
목적 평개화료동기흉부삼유방료Ⅳ기비소세포폐암(NSCLC)불동방료제량대생존적영향.방법 2003-2010년공입조201례,가평개182례.화료이박류위기출이약연합방안,중위주기수위4주기.흉내병조중위계화파체적제량위63 Gy.생존분석채용Kaplan-Meier법병Logrank 법검험,Cox회귀모형다인소예후분석.결과 201례수방솔위97.5％,수방만＜1、1～2、≥3년자분별위201、170、134례.182례1、2、3년생존솔화중위생존기분별위41％、17％、10％화10.5개월；방료제량＜45.0 Gy혹45.0～62.1 Gy이급≥63.0 Gy적분별위20％、14％、0％화7.1개월혹27％、10％、3％화9.6개월이급59％、22％、16％화14.9개월(χ2=27.88,P=0.000)；2～3개주기화료동기방료≥63 Gy이급＜63 Gy적분별위43％、19％、0％화11개월이급20％、11％、5％화8개월(χ2=2.99,P=0.084)；4～5개주기화료동기방료≥63 Gy이급＜63 Gy적분별위66％、23％、19％화16.0개월이급29％、12％、0％화8.8개월(χ2=15.87,P=0.000)；이2～3개주기화료동기방료≥63 Gy화4～5개주기화료동기방료＜63 Gy적생존차이무통계학의의(χ2=1.93,P=0.165).다인소분석현시4～5개주기화료동기방료≥63 Gy(β=0.243,P=0.019)、치료후잡씨평분변화(β=1.268,p=0.000)대생존유영향.결론 Ⅳ기NSCLC적4～5개주기화료동기흉내병조삼유방료제량≥63 Gy시가능현저연장생존.
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 (CCTTRT).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 ( DTPTV )was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression models were used to examine the effect of DTPTV 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 DTPTV ＜ 45.0 Gy,45.0 - 62.1 Gy and ≥63.0 Gy,respectively ( χ2 =27.88,P =0.000 ) ;43％,19％,0％and 1 1 months and 2 0 ％,1 1％,5 ％ and 8 months,respectively for those received 2 - 3 cycles of chemotherapy and radiation dose ≥63 Gy and ＜ 63 Gy,respectively (χ2 =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 ≥ 63 Gy and ＜ 63 Gy,respectively (χ2=15.87,P=0.000).No significant difference was found for patients received 2 - 3 cycles chemotherapy concurrently with DTP,Tv ≥63 Gy and 4 -5 cycles chemotherapy concurrently with DTPTV ＜63 Gy,respectively (χ2 =1.93,P =0.165).Multivariate analysis showed that 4 -5 cycles chemotherapy concurrently with DTPTv ≥63 Gy ( β =0.243,P =0.019),and improved KPS after treatment ( β =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 Gy.
