老年非小细胞肺癌三维适形放射治疗靶区选择探讨

SELECTION OF TARGET AREA FOR THREE DIMENSIONAL CONFORMAL RADIATION THERAPY FOR ELDERLY PATIENTS WITH NON-SMALL CELL LUNG CANCER

目的探讨老年晚期非小细胞肺癌(NSCLC)三维适形放射治疗(3R-CRT)不同靶区的设计对放射治疗效果及放射性损伤的影响。方法回顾分析94例应用3D-CRT治疗的65岁以上、病理确诊的NSCLC病人,其中以原发病灶、同侧肺门及淋巴引流区为放疗靶区的病例36例(A组);以原发病灶及累及淋巴结为靶区的病例58例(B组),比较两组的近期疗效、远期疗效和放射损伤的情况。结果两组近期疗效、中位生存期(MST)、1及2年生存率比较差异均无显著性(P>0.05)。两组放射性食管炎发生率比较差异有统计学意义(χ2=4.182、4.795,P<0.05),放射性肺炎、骨髓抑制及心脏损伤发生率差异无显著性(P>0.05)。结论老年NSCLC病人淋巴结区预防照射和累及野放疗,预后无明显差异,累及野放疗可减少放射性食管炎发生率,建议对老年病人采取累及野照射。

Objective To evaluate the therapeutic effect and radiation damage of different target areas in three dimensional conformal radiotherepy（3D-CRT） for elderly patients with non-small lung cancer（NSCLC）. Methods A retrospective analysis was done in 94 patients（age≥65） with NSCLC confirmed pathologically,who were divided into group A and group B.They were treated by 3D-CRT.For those in group A（36 cases）,the radiotherapy target area included primary lesion,ipsilateral hilum of lung,and related lymph nodes;those in group B（58 cases）,the radiation field was primary lesion and involved lymph nodes.The short-term and long-term efficacy and radiation damage were compared between the two groups. Results The differences between groups A and B were not significant in terms of short-term efficacy,median survival time（MST）,one-and two-year survival rate,radioactive pneumonia,bone marrow depression and heart damage（P0.05）,but there was a significant difference in radioactive esophagitis（χ2=4.182,4.795;P0.05）. Conclusion The prognosis has no significant difference between prophylactic radiation of related lymph node area and involved lymp nodes for the elderly with NSCLC.Involved field radiotherapy may decrease the incidence of radioactive esophagitis,which is,therefore,recommended for the elderly patients with NSCLC.