局部晚期非小细胞肺癌累及野三维适形放疗的预后分析

Prognosis of Three Dimensional Conformal Radiotherapy of Locally Advanced Non-small Cell Lung Cancer with Involved-field

目的探讨局部晚期非小细胞肺癌累及野三维适形放疗疗效及预后影响因素。方法 2004年3月—2007年12月在我科接受三维适形放疗的非小细胞肺癌115例,均经组织学或细胞学证实,累及野照射,常规分割每次1.8-2.0Gy,每日1次,每周5次,PTV剂量50Gy以上。对可能影响预后的相关指标进行单因素和多因素分析。结果全组1、2、3年生存率分别为63.4%、33.8%、18.0%,中位生存期为17月。Log-rank单因素分析显示性别、化疗周期数、GTV体积与患者预后相关（P=0.027、0.000、和0.002）。Cox回归多因素分析显示性别、化疗周期数、GTV体积是影响非小细胞肺癌患者生存的独立因素（P=0.037、0.029、0.008）。结论性别、化疗周期数、GTV体积是非小细胞肺癌患者独立的预后影响因素,累及野照射未增加野外复发。

Objective To evaluate and analyze the prognostic factors of locally advanced non-small cell lung cancer（LANSCLC） with involved-field three dimensional conformal radiotherapy（3D-CRT）.Methods One hundred and fifteen patients with NSCLC treated with involved-field 3D-CRT between March 2004 and December 2007 were analyzed and evaluated retrospectively.The PTV given dose was over 50 Gy,with 1.8~2.0 Gy per fraction,1 time a day,5 fractions a week.There were 42 and 73 patients received radiotherapy alone and chemoradiotherapy respectively.The volume of GTV was calculated on TPS.The impact of related prognostic factors on survival was evaluated by univariate and multivariate analysis.Results The 1,2 and 3-year survival rates were 63.4%,33.8% and 18.0%,respectively,and the median survival time was 17 months.Female,Smaller GTV and sufficient chemotherapy were favorable factors for survival in univariate and multivariate analysis（P=0.027,0.000,0.002 and P=0.037,0.029,0.008,respectively）.Conclusion Female,smaller GTV volume and optional chemotherapy are favorable prognostic factors for NSCLC.Involved-field 3D-CRT confers no increasing elective nodal failure.