常规设野与累及野照射局部晚期非小细胞癌的临床研究

The Clinical Research on Irradition with Conventional Field or Involved Field for Patients with Locally Advanced Non-small Cell Lung Cancer(NSCLC)

[目的]探讨局部晚期肺癌的放疗范围。[方法]87例局部晚期肺癌随机分为累及野组和常规野组,两组其他特征相似。[结果]全组中位生存时间12.00个月;1、2年总生存率分别为58.71%,17.93%,常规野组和累及野组疗效相似,1、2年生存率分别为59.31%,17.85%和57.86%,18.30%.(P>0.05),中位生存时间分别为12.14月和11.87月。常规野组和累及野组的治疗失败原因为病灶局部、远处转移、区域复发,分别为75.86%、55.17%、3.45%和70.27%、56.76%、5.40%(P>0.05)。常规野放射性肺炎的发生率Ⅰ～Ⅱ级32.5%,Ⅱ～Ⅲ级15.00%,累及野组Ⅰ～Ⅱ级27.66%,Ⅱ～Ⅲ级14.89%.常规野组Ⅳ级放射性肺炎2例。[结论]部晚期肺癌给予常规野(预防淋巴结区)和累及野放疗,预后无明显改善,累及野可减轻放射性肺炎程度,建议累及野照射。

[Objective] To study the optional field of radiotherapy for patients with locally advanced non-small cell lung cancer （NSCLC） by analysis of recurrence patterns when elective lyunph node irradiation was omitted. [Methods]87 patients with locally advanced NSCLC, were divided into two groups. [Results] All patients completed the treatment with a response rate of 80.00% and 78.82% in conventional field group and involved field group, respectively. Ⅰ-Ⅱ, Ⅱ-Ⅲgrade of pneumonia observed in eonventioual field group was 32.5% ,20% versus 27.66% ,14.89% ,respectively,in involved field group. Two of those patients in conven tional field group had Ⅳ grade pneumonia. The overall survival rate of 1-and 2-year was 58.71% and 17.93%, respectively, with median survival time of 12.00 months. The 1-and 2-year survived rale in patients with conventional field group andinvelved field group, was 59.31 % ,17.85and 57.86%, 18.30% （P〉0.05） with median survival time of 12.14 onouths and 11.87 months, respectivelly. The difference between the two radiotherapy was no significant（P〉0.05）. In-field recurences, distant recurrences and reginal recurrences developed in conventional field group 75.86%, 55.17%, 3. 45%, versus 70.27%, 56.76%, 5.40%. [Conclusion]Omitting elective lymph node irradiation did not cause a significant amount of failure in lymph node region involved in the clinical target votune, involved field iradiation did not reduce the survival. Therefore, we suggest involed field irradiation in patients with NSCLC.