块型非小细胞肺癌放疗疗效分析

Radiation treatment for 278 patients with massive non small cell lung cancer (NSCLC)

目的回顾性分析原发灶≥５ｃｍ的非小细胞肺癌放疗疗效及影响预后因素。材料与方法自１９７４年１月～１９８８年１２月共收治原发灶可测量、最小径≥５ｃｍ的非小细胞肺癌２７８例，男２３５例，女４３例。全部有组织学证实。Ⅰ期５例，Ⅱ期３７例，ⅢＡ期１７５例，ⅢＢ期６１例，伴有空洞４２例。照射方法采用６０Ｃｏ或８ＭＶ－Ｘ线外照射，常规前后野照射４０Ｇｙ／４周，然后避开脊髓缩野加量２０～３０Ｇｙ／２～３周。结果１，３，５年生存率分别为５１．０％，９．３％和５．０％。原发灶５ｃｍ×５ｃｍ～６ｃｍ×７ｃｍ和７ｃｍ×７ｃｍ～１０ｃｍ×１２ｃｍ的３，５年生存率分别为１１．６％，６．０％和３．８％，２．５％。Ⅰ，Ⅱ和Ⅲ期的３，５年生存率分别为８０．０％，６０．０％和１８．０％，１０．０％和６．０％，３．０％。空洞和非空洞３，５年生存率分别为２．４％，２．４％和１０．６％，５．０％。结论肿瘤≥５ｃｍ的情况下，肿瘤大小与空洞发生率无明显关系，预后与原发灶大小关系不大，而与临床分期。

Purpose To evaluate the prognosis and prognostic factors of non small cell lung cancer with lesion ≥ 5cm in diameter.Materials and Methods 278 patients of NSCLC with lesions≥5cm in diameter were treated by radiotherapy from January 1974 to December 1988(male 235 and female 43). All patients were proved by pathology. There were stage Ⅰ 5,stage Ⅱ 37,stageⅢ A 175 and stage Ⅲ B 61 patients. Cavitation was present in 42 cases. Telecobalt or 8 MV X rays was used in external irradiation. 40Gy/4 weeks was given first through A P portals. Then a boost dose of 20～30Gy/2～3 weeks was supplemented through reduced portals.Results The 1 ,3 and 5 year survival rates of primary lesions with diameters 5cm×5cm～6cm×7cm and 7cm×7cm～10cm×12cm were 11.6%,6.0% and 3.8%,2.5%,respectively. The 3 and 5 year survival rates of stage Ⅰ,Ⅱ and Ⅲ lesions were 80.0%,60.0%,18.9%,10.0% and 6.0%,3.0%. The 3 and 5 year survivals for patients with cavitation and non cavitated lesions were 2.4%,2.4% and 10.6 %,5.0%,respectively.Conclusion The prognosis of massive NSCLC with the primary lesions≥5cm is not related to tumor size or the presence of cavitation when radiotherapy is given,but is releted to the clinical stage and local control by radiation .