中华临床医师杂志(电子版) 2017年2月,11卷4期

临床论著

原发灶及转移灶放疗在Ⅳ期寡转移非小细胞肺癌中的疗效分析

张矛 孙涛 崔洪霞 张劲

130012 长春,吉林省肿瘤医院肿瘤放疗三科1,肿瘤内一科2
孙涛,Email: 86347916@qq.com

摘要:目的 评价原发灶及转移灶放疗在Ⅳ期寡转移非小细胞肺癌治疗中的作用,并探讨潜在的影响生存预后因素。方法 回顾性分析2009年1月至2014年8月在本院治疗的288例Ⅳ期非小细胞肺癌病例(伴有1~3个转移灶),经4~6个周期化疗有效后,随机分为放疗组和化疗组,放疗组给予胸部以及部分转移灶放疗,放疗组原发灶照射剂量为肿瘤吸收剂量(DT)56~60 Gy/(28~30)次,转移灶照射剂量为DT 30~56 Gy/(10~28)次,观察两组疗效、无进展生存率和总生存率,分析预后因素,同时评估不良反应等。结果 放疗组有效率为31.91%,肿瘤控制率为87.23%;化疗组有效率为22.44%,肿瘤控制率为71.47%,放疗组的近期疗效优于化疗组,两组比较差异有统计学意义(P=0.001)。放疗组1、2、3年无进展生存率分别为48.94%、20.57%、15.60%;化疗组1、2、3年无进展生存率分别为28.57%、10.20%、7.48%,两组比较差异有统计学意义(P<0.05)。放疗组1、2、3年生存率分别为58.15%、29.79%、16.31%;化疗组1、2、3年生存率分别为37.41%、19.05%、8.16%,两组比较差异有统计学意义(P<0.05)。单因素及多因素分析显示,功能状态评分较好、腺癌、体质量下降<5%、肺内转移、接受放疗是患者无进展生存率较高的预后因素,女性、功能状态评分较好、体质量下降<5%、转移数目较少、肺内转移、接受放疗是患者生存率较高的预后因素。所有患者耐受性良好。结论 对于转移灶数目较少(寡转移)的晚期非小细胞肺癌,全身治疗后予以原发灶及转移灶的放疗可以改善患者生存,但是尚需进一步前瞻性、多中心、随机对照临床研究加以验证。

关键词: 癌,非小细胞肺; 放射疗法; 治疗结果; 预后

吉林省卫生计生科研项目(2015S017)

Efficacy of the primary and metastatic sites radiotherapy in oligometastasis stage Ⅳ non-small cell lung cancer

Zhang Mao1, Sun Tao1, Cui Hongxia2, Zhang Jin1.

1The Third Department of Radiation Oncology, 2The First Department of Medical Oncology, Jilin Province Cancer Hospital, Jilin 130012 China
Sun Tao, Email: 86347916@qq.com

Abstract:Objective To determine the effects of radiotherapy (RT) to primary and metastatic sites in limited stage Ⅳ non-small cell lung cancer (NSCLC) patients and investigate the potential prognostic factors for survival. Methods A retrospective study involving 288 stage Ⅳ NSCLC patients (1-3 metastatic lesions) who underwent chemotherapy with or without RT was carried out at our institution from January 2009 to August 2014. All patients were given 4-6 weeks chemotherapy and responses to chemotherapy, were randomly divided into RT group and chemotherapy alone group, patients in the RT group (chemotherapy plus RT) received 56-60 Gy/(28-30) fractions to the primary tumor and 30-56 Gy/(10-28) fractions to the metastatic lesions, while patients in the control group received chemotherapy only. The 1, 2, 3-year overall survival rates, local control rates, progression-free survival rates, and adverse reactions were estimated, and the univariate and multivariate analyses were done for the prognostic factors. Results The efficiency rates in RT group were significantly higher than those in the control group (31.91% and 22.44%, respectively). The tumor control rates in RT group were significantly higher than those in the control group (82.23% and 71.47%, respectively). The curative effects in RT group were significantly higher than those in the control group (P=0.001). The progression-free survival rates after 1, 2, and 3 years in the RT group were significantly higher than those in the control group (48.94%, 20.57%, 15.60% and 28.57%, 10.20%, 7.48%, respectively). Similarly, the overall survival rates after 1, 2, and 3 years in the RT group were also significantly higher than those in the control group (58.15%, 29.79%, 16.31% and 37.2%, 19.2%, 8.2%, respectively). In both uni- and multivariate Logistic regression analyses, PS, adenocarcinoma, site of metastasis, weight loss and RT were independent prognostic factors for disease-free survival and gender, PS, site of metastasis, numbers of metastatic lesions, weight loss and RT were independent prognostic factors for overall survival. All patients well tolerated the treatments. Conclusions The study suggests that RT to primary and metastatic sites is a potential treatment for stage Ⅳ NSCLC patients with oligometastasis. A prospective, multi-institutional, randomized trial of radiotherapy in stage Ⅳ non-small cell lung cancer is urgently needed

Keywords: Carcinoma, non-small-cell lung; Radiotherapy; Treatment outcome; Prognosis

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(编辑:吴莹 收稿日期:2016-10-09)