Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)——不同放疗剂量对生存的影响

doi:10.3760/cma.j.issn.1004-4221.2012.01.008

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摘要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。

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	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

关键词 ：癌, 非小细胞肺/同期化放疗法, 放射疗法, 三维, 放疗剂量, 预后

Abstract：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 (DT_PTV) 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 DT_PTV 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 DT_PTV<45.0 Gy,45.0－62.1 Gy and ≥63.0 Gy,respectively (χ²=27.88,P=0.000);43%,19%,0%and 11 months and 20%,11%,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 DT_PTV≥63 Gy and 4－5 cycles chemotherapy concurrently with DT_PTV<63 Gy, respectively (χ²=1.93,P=0.165). Multivariate analysis showed that 4－5 cycles chemotherapy concurrently with DT_PTV≥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 DT_PTV ≥63 Gy.

Key words： Carcinoma, non-small cell lung/concurrent chemoradiotherapy Radiotherapy, three-dimensional Radiotherapy dose Prognosis

收稿日期: 2011-06-21

基金资助:贵州省科技公关项目\[SY〔2010〕3078\];贵州省科学技术自然基金项目\[J〔2010〕2186\]

通讯作者: 卢冰 E-mail: lbgymaaaa@sohu.com

引用本文:

龙金华,卢冰,欧阳伟炜等. Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)——不同放疗剂量对生存的影响[J]. 中华放射肿瘤学杂志, 2012, 21(1): 23-26.

LONG Jin-hua^*,LU Bing,OUYANG Wei-wei et al. A prospective study on concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage Ⅳ non-small cell lung cancer (3)— The impact of radiation dose to thoracic primary tumor on survival[J]. Chinese Journal of Radiation Oncology, 2012, 21(1): 23-26.

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