非小细胞肺癌术后三维适形放疗与常规放疗结果比较

Comparison of postoperative three-dimensional conformal radiotherapy with conventional radiotherapy for non-small cell lung cancer

目的回顾性比较非小细胞肺癌术后三维适形放疗（3DCRT）和常规放疗的疗效、失败模式及副反应。方法分析3年余接受术后放疗的ⅠB～ⅢB期非小细胞肺癌患者162例，其中86例采用3DCRT，76例采用常规放疗。结果总随访率91．5％，3DCRT和常规放疗的中位随访时间分别为29．4个月和33．8个月。3DCRT和常规放疗的1、2、3年无局部进展生存率分别为97．5％、83．2％、83．2％和84．3％、76．0％、65．6％（χ^2=5．46，P=0．019），总生存率、无疾病进展生存率和无远转生存率均相似；总局部区域失败率分别为14．5％和33．3％（χ^2=7．70 P=0．006），远处转移率两组相似。2—3级放射性肺炎发生率3DCRT显著低于常规放疗（11．6％：23．7％ χ^2=4．10，P=0．043）。结论术后放疗采用3DCRT技术比常规放疗技术能提高局部控制率，降低放疗相关副反应发生率。

Objective To compare postoperative three-dimensional conformal radiotherapy （3DCRT） and conventional radiotherapy （CR） in patients with non-small-cell lung cancer （NSCLC）. Methods From Nov. 2002 to Mar. 2006,162 patients with stage Ⅰ B-Ⅲ B NSCLC receiving postoperative radiotherapy in our department were restrospetcively analyzed. Among them ,86 received 3DCRT and 76 received CR. The survival outcome, pattern of failure and treatment-related side effects in both groups were analyzed. Results The median follow-up was 29.4 months in the 3DCRT group and 24 months in the CR group. The 1-,2- and 3-year local-regional free survival was 97.5% ,83.2% and 83.2% in 3DCRT group, and 84.3% ,76.0% and 65.6% in CR group（ χ^2 = 5.46, P = 0. 019）, respectively. No statistically significant difference was found in the overall survival, disease-free survival or distant metastasis-free survival between the two groups. The local-regional failure rate was statistically different between the two groups （14.5% vs 33.3% ,X2 =7.70,P =0. 006）. The incidence of distant metastasis in the two groups was similar. Radiation pneumonitis of NCI CTC grade 2-3 occurred in 10 patients（ 11.6% ）in 3DCRT group and 18 （23.7%） in CR group, which was statistically different （ χ^2 = 4.10, P = 0. 043 ）. Conclusions Postoperative 3DCRT for NSCLC provides a better local-regional control and lower incidence of radiation pneumonitis compared with CR.