老年Ⅳ期非小细胞肺癌三维放疗重要性研究

The study on importance of three-dimensional radiotherapy for elderly patients with stage

目的探讨老年Ⅳ期非小细胞肺癌（NSCLC）三维放疗的重要性。方法2003—2010年间201例NSCLC化疗同期三维放疗疗效患者入组，其中老年（≥65岁）和〈65岁患者分别为67例和134例。Kaplan—Meier法生存分析，Cox模型多因素预后分析。结果随访率为97．8％。≥65岁和〈65岁患者完成4～5周期化疗分别占30％和55％，放疗剂量≥63Gy分别占42％和49％。365岁和〈65岁4～5周期化疗同期≥63Gy放疗的中位生存期（MST）分别为17个月和14个月（x2=0．76，P=0．384）。全组患者放疗363Gy和〈63Gy的MST、1、2、3年生存率分别为17个月和8个月、65％和23％、30％和13％、24％和9％（x2=7．90，P=0．005），任何化疗强度均示363Gy较〈63Gy的MST显著延长（x2=9．54，P=0．023）。365岁、放疗363Gy者同期d～5周期和2～3周期化疗的MST分别为14个月和8个月（X2=1．82，P=0．178）、17个月和17个月（x。=0．47，P=0．492）。多因素预后分析显示近期疗效（p=0．600，P=0．003）、肿瘤转移数（p=0．670，P=0．040）对生存有影响。结论化疗同期三维放疗延长部分老年Ⅳ期NSCLC生存期，三维放疗的重要性对老年患者个体化治疗更明显。

Objective To evaluate the importance of three-dimensional radiotherapy for elderly patients of stage Ⅳ non-small cell lung cancer （NSCLC）. Methods Comparing with treatment outcome of ≥65 years 67 patients and 〈 65 years 134 patients using concurrent chemotherapy and thoracic three-dimensional radiotherapy during 2003 to 2010 years. Survival analysis was taken by Kaplan-Meier method. The multivariate prognosis was analyzed by Cox model. Results The follow-up was 97.8%. The percentage of 〉165 years and 〈 65 years patients accepted with concurrent 4 - 5 cycles chemotherapy were 30% and 55%, and with 42% and 49% patients with radiotherapy≥63 Gy. The median survival time （MST） were 17 months and 14 months （ X2 = 0. 76, P = 0. 384） for ≥65 years and 〈 65 years patients accepted with concurrent 4 -5 cycles chemotherapy concurrent t〉63 Gy radiotherapy respectively. The MST and 1-, 2-,5- year overall survival rate were 17 months and 8 months,65% and 23% , 30% and 13% , 24% and 9% （X2 = 7.90 ,P = 0. 005 ） for whole groups patients treated with chemotherapy concurrent ≥ 63 Gy and 〈 63 Gy radiotherapy. And the MST of patients t〉 63 Gy was significantly longer than those with 〈 63 Gy either concurrent chemotherapy any cycles （ X2 = 9.54 ,P = 0. 023 ）. The MST were 14 months and 8 months （X2 = 1.82,P=0.178）,17 months and 17 months （X2=0.47,P=0.492） for ≥ 65 years and ≥ 63 Gy radiotherapy patients accepted with concurrent 4 - 5 cycles and 2 - 3 cycles chemotherapy concurrent respectively. Multivariate analysis showed local response （ 13 = 0. 600, P = 0. 003 ） and numbers of tumor metastasis （ [3 = 0. 670, P = 0. 040 ） were independent factors for survival. Conclusions For a part of elderly patients of stage Ⅳ NSCLC, concurrent chemotherapy and thoracic three-dimensional radiotherapy can prolong survival time with acceptable toxicity. Perhaps radiotherapy is more important.