摘要
目的评估三维适形放疗局部晚期非小细胞肺癌的长期疗效、放疗毒副反应及影响患者的预后因素。方法2000年11月至2004年5月在河北医科大学第四医院接受根治性三维适形放疗并经病理或细胞学证实的Ⅲa／Ⅲb期非小细胞肺癌患者106例。46例接受单纯放射治疗；另60例接受化疗，其中同期化疗41例，序贯化疗19例。对相关临床指标进行单因素、多因素分析，并用预后指数模型综合评价放疗疗效。结果全组患者治疗后，1、3、5年生存率分别为50．O％、22．2％、15．5％；1、3、5年局部控制率分别为80．2％、53．8％、32．7％；中位生存期12个月。其中单纯放疗、序贯放化疗及同期放化疗的中位生存期分别为10、12及13个月；Ⅲa与Ⅲb期患者中位生存时间分别为13、10．2个月。单因素分析结果显示，性别、治疗前卡氏评分、病理类型、锁骨上淋巴结、吸烟状况、治疗前血红蛋白值、N分期、瘤体最大直径、肿瘤体积、GTV大小及近期疗效为患者预后影响因素；多因素分析结果显示，吸烟状况、GTV大小及治疗前血红蛋白值为预后独立影响因素。全组92级放射性食管炎18例，占17．0％；≥2级放射性肺炎39例，占36．8％；≥3级血液学毒性反应11例，占10．4％。结论三维适形放射治疗局部晚期非小细胞肺癌显示了较好的疗效，吸烟状况、GTV大小及治疗前血红蛋白值为非小细胞肺癌患者预后的主要影响因素。预后指数模型能够显著提高多指标联合的预测价值。
Objective To evaluate the prognostic factors of locally advanced non-small cell lung cancer（LA-NSCLC） treated with three dimensional conformal radiation therapy （3D CRT）. Methods In 106 patients with stage Ⅲa/Ⅲb NSCLC treated with 3DCRT from Nov 2000 to Mar 2004, 46 of them were treated with radiotherapy alone, 41 by concurrent chemoradiation, and 19 by sequential chemoradiation. The influence of related prognostic factors on survival was evaluated by univariate and multivariate analysis. The treatment outcome was analyzed by prognostic index model. Results The 1-, 3- and 5- year overall survival rate was 50. 0% , 22.2% and 15.5% , respectively, and the median survival time was 12 months. The univariate analysis showed that the following factors were significantly associated with the longer survival： female, good kamofsky performance status （KPS）, squamous cell carcinoma, absence of supraelavicular lymph nodes, no smoking history, hemoglobin ≥ 130 g/L before treatment, N stage, the maximum diameter of tumor ≤5 cm, the volume of tumor ≤90 cm^3 , GTV ≤ 150 cm^3 and the radiotherapy efficacy. However, multivariate analysis revealed that no smoking history, hemoglobin ≥ 130 g/L and GTV≤150 cm^3 were the independent risk factors for predicting the survival. Conclusions Three dimensional conformal radiation therapy could be effective in the treatment of locally advanced NSCLC. No smoking history, hemoglobin ≥ 130 g/L and GTV ≤150 cm^3 might be the independent risk factors for predicting the survival. Prognostic index model could improve the potential of multivariate analysis in predicting the survival of patients treated with radiotherapy for NSCLC.
出处
《中华放射医学与防护杂志》
CAS
CSCD
北大核心
2010年第2期180-184,共5页
Chinese Journal of Radiological Medicine and Protection
基金
河北省自然科学基金（2005000802）
河北省普通高校强势特色学科课题
关键词
非小细胞肺癌
三维适形放射治疗
预后
Non-small cell lung cancer
Three dimensional conformal radiotherapy
Prognosis
