Ⅳ期非小细胞肺癌287例放疗后的生存分析

Survival Status of Stage Ⅳ Non-small Cell Lung Cancer Patients after Radiotherapy——A Report of 287 Cases

背景与目的:很多Ⅳ期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的患者需要放疗,特别是对脑、骨转移者放疗有很好的治疗作用。本研究旨在分析放疗对Ⅳ期NSCLC患者生存的影响。方法:对287例资料完整的Ⅳ期NSCLC放疗患者进行回顾性分析。脑放疗为平行对穿两野全脑照射,骨放疗为单野局部照射,对原发灶、区域淋巴结和其它转移部位用2维常规分割或3维适形放疗(3dimensionalconformalradiotherapy,3D-CRT)。脑和骨放疗通常采用4周20次共40Gy或2周10次共30Gy的治疗方案,原发灶和区域淋巴结的中位照射剂量是50Gy(20～70Gy),其它转移部位的中位照射剂量是46Gy(40～60Gy)。结果:全部患者中位生存期9个月(8～10个月),1年和2年生存率分别是30.2%和8.9%。有化疗和无化疗者中位生存期分别为10个月和8个月(P=0.049)。有脑转移、骨转移、其它转移者中位生存期分别为8个月、9个月、10个月,1年生存率分别24.8%、28.7%和37.5%,2年生存率分别为6.7%、7.0%和15.3%。单因素分析发现对生存有显著影响的因素为病理类型和年龄。腺癌患者的生存期高于鳞癌和其它病理类型,中位生存期分别为10个月、7个月、9个月(P=0.046);≤60岁的患者生存期显著高于>60岁的患者,中位生存期分别为11月、8个月(P=0.012);单纯骨转移患者的中位生存期要大于合并有其它转移者(10个月与6个月,P=0.033),而单纯脑转移和同时合并有其它转移的两组患者中位生存期却无明显差异(9个月与8个月,P=0.3742);肿瘤原发灶和区域淋巴结是否放疗对患者生存时间影响不大(10个月与8个月,P=0.066);是否伴有其它慢性疾病对患者的生存期无明显影响(9个月与10个月,P=0.306)。对脑和骨转移的患者采用4周20次40Gy或2周10次30Gy放疗对生存期无明显影响。结论:病理类型、年龄对Ⅳ期NSCLC患者的放疗疗效有显著影响,全脑和骨转移采用4周20次40Gy或2周10次30Gy放疗对生存期无明显影响。

BACKGROUND ＆ OBJECTIVE： The patients with stage Ⅳ non-small cell lung cancer （NSCLC） usually need radiotherapy and have good responses, particularly in those with brain or bone metastases. This study was to evaluate the influence of radiotherapy on the survival of stage Ⅳ NSCLC patients. METHODS： Clinical data of 287 patients with stage Ⅳ NSCLC were retrospectively analyzed. Whole brain was treated with two parallel fields irrdiation; bone metastases were treated with one local field irrdiation. Primary tumors, regional lymph nodes and other distant metastases were treated by conventional fractionation radiotherapy or 3-dimensional conformal radiotherapy. Whole brain and bone radiotherapy was delivered with a total dose of 40 Gy in 20 fractions in 4 weeks or with a total dose of 30 Gy in 10 fractions in 2 weeks. The median dose for primary tumors and regional lymph nodes was 50 Gy （20-70 Gy）, and the median dose for other distant metastases was 46 Gy （40-60 Gy）. RESULTS. The median survival time of the 287 patients was 9 months （8-10 months）. The 1- and 2-year overall survival rates were 30.2% and 8.9%. The median survival time was significantly longer in the patients received chemotherapy than in the patients didn＇t （10 months vs. 8 months, P = 0.049）. In the patients with brain, bone, or other distant metastases, the median survival time was 8, 9, and 10 months, respectively; the 1-year survival rates were 24.8%, 28.7%, and 37.5%, respectively; the 2-year survival rates were 6.7%, 7%, and 15.3%, respectively. By unitivariate analysis, histological type and patients＇ age were prognostic factors of NSCLC. The median survival time was significantly longer in adenocarcinoma patients than in squamous cell carcinoma patients and other carcinoma patients （10 months vs. 7 and 9 months,P = 0.046）, longer in the patients of ≤60 years old than in those of 〉60 years old （11 months vs. 8 months, P = 0.012）, and longer in the patients with only bone metastases than in the patients with concomitant other distant metastases （10 months vs. 6 months, P = 0.033）, but there was no significant difference between the patients with only brain metastases and those with concomitant other distant metastases （9 months vs. 8 months, P = 0.374）. Radiotherapy for primary tumors and lymph nodes, complications of other chronic diseases, and irradiation dose and pattern had no effect on the survival. CONCLUSIONS： Histological type and patients＇ age may affect the efficacy of radiotherapy on stage IV NSCLC. The irradiation patterns of 40 Gy in 20 fractions in 4 weeks or 30 Gy in 10 fractions in 2 weeks have no effect on the survival of patients with brain or bone metastases.