CAJ | 학술논문

目的：分析进展期非小细胞肺癌患者采用短疗程、大分割胸部姑息放疗（palliative thoracic radiotherapy，PTR）的疗效及其不良反应。方法：回顾性分析天津医科大学肿瘤医院2010年9月至2012年7月行PTR的ⅢB期及Ⅳ期非小细胞肺癌患者共25例，其计划靶区（PTV）剂量为45 Gy/15 f，单次剂量3 Gy。评价PTR后症状缓解情况、放疗疗效及相关不良反应。Kaplan-Meier法进行生存分析并用Log-rank进行检验。结果：除1例患者只完成36 Gy/12f外，其余24例均完成全部放疗计划。18例患者的胸部症状得到缓解，患者咳血症状缓解率为87.5%（7/8），咳嗽为70.6%（12/17），胸痛为73.3%（11/15），呼吸困难为57.1%（8/14），声音嘶哑为50%（1/2）。PTR后胸部病灶达部分缓解（PR）+完全缓解（CR）为28%（17/25），未发现3级及以上放疗相关不良反应。患者的中位生存（overall survival，OS）为13个月（95%CI 6.6~19.5个月），1年OS为51.5%（17/25）。单因素分析显示，PTR前KPS评分、PTR后化疗周期数是影响生存的重要因素。结论：对于进展期NSCLC患者，采用45 Gy/15 f短疗程、PTR剂量分割模式缩短了治疗时间，明显改善了患者的胸部症状，提高了OS，且近期不良反应较低，值得进一步进行大样本前瞻性随机分组研究。
목적：분석진전기비소세포폐암환자채용단료정、대분할흉부고식방료（palliative thoracic radiotherapy，PTR）적료효급기불량반응。방법：회고성분석천진의과대학종류의원2010년9월지2012년7월행PTR적ⅢB기급Ⅳ기비소세포폐암환자공25례，기계화파구（PTV）제량위45 Gy/15 f，단차제량3 Gy。평개PTR후증상완해정황、방료료효급상관불량반응。Kaplan-Meier법진행생존분석병용Log-rank진행검험。결과：제1례환자지완성36 Gy/12f외，기여24례균완성전부방료계화。18례환자적흉부증상득도완해，환자해혈증상완해솔위87.5%（7/8），해수위70.6%（12/17），흉통위73.3%（11/15），호흡곤난위57.1%（8/14），성음시아위50%（1/2）。PTR후흉부병조체부분완해（PR）+완전완해（CR）위28%（17/25），미발현3급급이상방료상관불량반응。환자적중위생존（overall survival，OS）위13개월（95%CI 6.6~19.5개월），1년OS위51.5%（17/25）。단인소분석현시，PTR전KPS평분、PTR후화료주기수시영향생존적중요인소。결론：대우진전기NSCLC환자，채용45 Gy/15 f단료정、PTR제량분할모식축단료치료시간，명현개선료환자적흉부증상，제고료OS，차근기불량반응교저，치득진일보진행대양본전첨성수궤분조연구。
Objective:To investigate the effect and toxicity of short-course and hypofractionated palliative thoracic radiotherapy (PTR) for advanced non-small cell lung cancer (NSCLC). Methods:A total of 25 patients with stageⅢB and stageⅣNSCLC, who underwent PTR from September 2010 to July 2006, were retrospectively analyzed. The PTR regime was 45 Gy in 15 fractions. Symptom relief, effect, and toxicity after completion of PTR were assessed. Survival was analyzed using the Kaplan-Meier method. Results:Except for one patient who completed only 36 Gy in 12 fractions, all other patients completed all plans. The thoracic symptoms of 18 patients were relieved. The response rates for the five main symptoms were:hemoptysis 87.5%(7/8), cough 70.6%(12/17), pain 73.3%(11/15), dyspnea 57.1%(8/14), and hoarseness 50%(1/2). The complete response and partial response after PTR was 28%, and no grade 3 or higher toxicities occurred. The median time of overall survival (OS) is 13 months (95%CI:6.6 months to 19.5 months), and one-year OS is 51.5%. According to the univariate analysis, KPS before PTR, the number of post-PTR was significantly related to the survival. Conclusion:For advanced NSCLC patients, the PTR regime given as 45 Gy in 15 fractions evidently relieved thoracic symptoms, improved OS, and shortened treatment time. Recent relevant adverse radiotherapy reactions are low, and more prospective clinical studies must be conducted.