老年晚期非小细胞肺癌累及野三维适形放疗疗效观察

Clinic investigation of involved-field irradiation in three-dimensional conformal radiation for old patients of advanced NSCLC

目的探讨老年晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)在适形放射治疗中累及野照射组(involved-field irradiation,IFI组)与预防照射组(elective node irradiation,ENI组)的疗效及放射性损伤的比较。方法将64例老年晚期NSCLC患者随机分为IFI组(仅照射原发灶和大于1cm的淋巴结)和ENI组(包括原发病灶、同侧肺门、隆突下及隆突以上纵隔淋巴引流区,当上纵隔有淋巴结转移时包括锁骨上淋巴引流区)处方量均为60～64Gy/30～32F,比较两组的近期疗效和放射损伤。结果IFI组和ENI组比较,CR和总有效率差异无显著性,P>0.05。1年内IFI组和ENI组的复发率比较差异无统计学意义。IFI组和ENI组急性放射性肺炎发生率分别为31.2%和43.8%,差异具有统计学意义,P<0.05。IFI组骨髓抑制和心脏损伤低于ENI组,但差异无统计学意义,放射性食管炎IFI组也低于ENI组,P<0.05,差异具有统计学意义。结论IFI治疗老年晚期NSCLC,总有效率与ENI组无明显差异,放射性肺炎的发生率低于ENI组,改善了患者的生活质量。

Objective To evaluate the efficacy and the side effects between in- volved-field irradiation（IFI） and elective node irradiation （ENI） in old patients of ad- vanced non-small cell lung cancer （NSCLC）. Methods 64 old patients with advanced NSCLC were randomized into IFI group （only irradiated primary tumor and 〉 lcm ly- mph nodes） and ENI group （including primary tumor 、ipsilateral hilar 、 mediastinum draining lymphatic areas of upper and lower carina, upper clavivle draining lymphatic areas when lymph nodes metastasis in upper mediastinum）, two groups were both irra-diated by 60-64Gy/30-32F. The short-time curative effect and the side effect were compared. Results In IFI group and ENI group, the CR and the overall response （CR ＋ PR） rates were no significance, P 〉 0. 05. The relapse rate between two groups were no significance, P 〉 0. 05. Radiation induced pneumonitis occurred 31.2% of patients in IFI and 43.8% in ENI, the difference were significant, P 〈 0. 05. Bone marrow depression and heart damage were lower in IFI group than in ENI group, but there were no signi- ficance. Radiation esophagitis incidence were lower in IFI than in the ENI group, it was statistically significant, P 〈 0.05. Conclusion IFI for the old patients of advanced NSCLC is well tolerated. The overall response rate is not higher than in ENI. But the radiation induced pneumonitis is lower in IFI than in ENI, that improve the survival.