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目的观察非小细胞肺癌(NSCLC)应用三维适形放疗(3DCRT)或3DCRT联合化疗的疗效和安全性,并分析影响其预后的因素。方法将随访资料完整的107例NSCLC患者纳入分析,其中接受单纯3DCRT 26例,3DCRT联合化疗81例。3DCRT剂量2Gy/次,5次/周,中位DT 60Gy。评价近期疗效及毒副反应。应用Kaplan-Meier法和多因素Cox模型分析全组NSCLC患者的生存预后情况。结果全组患者获CR 10例(9.3%),PR 56例(52.3%),SD 30例(28.0%),PD 11例(10.4%),总有效率(RR)为61.7%(66/107)。随访14～62个月,中位随访27个月,随访率为96%。1、3、5年的生存率分别为67%、31%和22%,中位总生存时间(OS)为20.2个月。急性放射性肺炎2级3例,3级2例;晚期放射性肺炎2级1例,3级1例。急性放射性食管炎1级49例,2、3级9例。骨髓抑制1、2级32例,3、4级5例。单因素分析显示,临床分期、KPS评分、肿瘤体积、放疗剂量、治疗模式及近期疗效显著影响OS,而年龄、体重减轻及病理类型对OS无影响。Cox多因素分析显示,临床分期、治疗模式和近期疗效是影响预后的独立因素。结论 3DCRT联合化疗治疗NSCLC的近期疗效较好,毒副反应可耐受;临床分期、治疗模式和近期疗效可能是影响NSCLC预后的因素。
Objective To observe the efficacy and safety of three-dimensional conformal radiotherapy (3DCRT) or 3DCRT combined with chemotherapy in non-small cell lung cancer (NSCLC) and to analyze the factors influencing its prognosis. Methods A total of 107 NSCLC patients with follow-up data were included in the analysis. Among them, 26 cases were treated with simple 3DCRT and 81 cases were treated with 3DCRT combined with chemotherapy. 3DCRT dose 2Gy / time, 5 times / week, the median DT 60Gy. Evaluation of the recent efficacy and side effects. Kaplan-Meier method and multivariate Cox model were used to analyze the prognosis of all patients with NSCLC. Results All patients were CR (9.3%), PR 56 (52.3%), SD 30 (28.0%) and PD 11 (10.4%). The total effective rate was 61.7% ). The follow-up ranged from 14 to 62 months. The median follow-up was 27 months. The follow-up rate was 96%. The 1-, 3- and 5-year survival rates were 67%, 31% and 22%, respectively. The median overall survival time (OS) was 20.2 months. Acute radiation pneumonitis grade 2 in 3 cases, grade 3 in 2 cases; advanced radiation pneumonitis in 2 cases in 1 case, 3 cases in 1 case. Acute esophagitis in 49 cases of grade 1, 2,3 in 9 cases. Myelosuppression in 1, 2 and 32 cases, 3,4 and 5 cases. Univariate analysis showed that OS, clinical stage, KPS score, tumor volume, radiation dose, treatment mode and short-term efficacy significantly affected OS, while age, weight loss and pathological type had no effect on OS. Cox multivariate analysis showed that clinical staging, treatment modalities and short-term efficacy were independent prognostic factors. Conclusion The combination of 3DCRT and chemotherapy in the treatment of NSCLC has a good short-term curative effect and tolerable side effects. The clinical staging, treatment modalities and short-term curative effect may be the factors affecting the prognosis of NSCLC.