选择性淋巴引流区照射对局部晚期非小细胞肺癌三维适形放疗疗效的影响

Improved local control without elective nodal in unresectable NSCLC patients treated by 3D-CRT

目的 探讨不能手术的局部晚期非小细胞肺癌放射治疗靶区包括和不包括淋巴结引流区对疗效的影响。方法55例非小细胞肺癌患者被前瞻性随机分组为选择性淋巴结引流区照射组（ENI）和不包括选择性淋巴引流区照射组（non．ENI），患者均在2～4周期诱导化疗后行根治性放射治疗。结果ENI组和non-ENI组GTV平均照射剂量分别为58．2Gy和为65．8Gy（P〈0．05），有效率分别是45．8％和74．0％（P〈0．05），CTV以外区域淋巴结复发（ENF）发生率分别为4．2％和11．1％（P〉0．05）。Kaplan-Meier分析结果表明，两组中位局部无进展时间为11和15个月，1年局部失败率为51．9％和24．5％（P〈0．05）；总体中位生存期分别为13．0和15．0个月（P=0．084），1年生存率分别为55．7％和72．5％，2年生存率分别为0％和19．9％。两组治疗相关并发症的发生率差异无统计学意义。结论不能手术的局部晚期非小细胞肺癌，根治性放疗不作选择性淋巴引流区照射，可以提高原发灶和肿大淋巴结的照射剂量，提高局部控制率，延长患者的无进展生存期和总体生存期，并且没有增加治疗相关性并发症。

Objective To investigate the influence of prophylactic elective nodal irradiation （ENI） on therapeutic results of definitive radiotherapy for patients with unresectable non-small-cell lung cancer. Methods 55 patients with inoperable advanced stage non-small-cell lung cancer were recruited. After 2-4 cycles of induction chemotherapy, patients were randomly divided into two groups prospectively. For one group, regions of elective nodal irradiation were included in target volumes; for the other group, regions of elective nodal irradiation were not included. Results The mean prescription doses to gross tumor volumes with ENI and non-ENI were 58.4 Gy and 65.8 Gy （ P 〈 0.05）, the responsive rates were 45.8% and 74.0% （ P 〈 0.05）, and the elective nodal failure （ENF） rates were 4.2% and 11.1%, respectively. Kaplan-Meier analysis showed that the mean local- progression- free survival time was 11.0 and 15.0 months, and 1-year local- failure rates were 51.9 % and 24.5% （P 〈 0.05）, while the median overall survival time was 13.0 and 15.0 months, respectively （P = 0.084）. The 1-year survival rates were 55.7% and 72.5% , and 2-year survival rates were 0% and 19.9% . There was no significant difference among occurrences of radiation-associated complications. Conclusions Omitting elective nodal irradiation did not increase incidence of elective nodal failure. On the contrary, it decreased local failure rate by increasing prescription doses to the primary diseases and lympbadenopapby. Thus it may further prolong patients＇ survival.