Ⅳ期非小细胞肺癌姑息性放疗临床价值回顾性分析

Retrospective analysis of palliative radiotherapy for treatment of stage Ⅳ NSCLC

目的:回顾性分析姑息性放疗对Ⅳ期非小细胞肺癌(NSCLC)患者预后及生存质量的影响。方法:收集2000-01-01-2009-12-30不能耐受化疗或拒绝化疗而接受姑息性放射治疗的Ⅳ期NSCLC 318例患者的临床病例资料,采用6 MVX射线加速器或60 Co-γ治疗机给予胸部原发灶及转移灶姑息性放疗,部分患者给予化疗。K-M法进行生存率的计算,Log-rank进行单因素分析,Cox回归行多因素分析。结果:318例NSCLC患者1、2年生存率和中位生存时间分别为25.2%、7.4%和7个月。放疗后症状缓解率:咳嗽72.4%,胸痛80.6%,咯血88.1%,呼吸困难60.8%,声嘶19.2%,骨转移疼痛及脑转移症状和体征有不同程度缓解甚至消失:骨转移76.8%,脑转移75.7%。单因素分析示,KPS评分、病理类型、脑转移、多器官转移、原发灶放疗剂量与预后相关。多因素分析示,KPS评分、多器官转移是影响患者生存的独立预后因素。结论:姑息性放射治疗在Ⅳ期NSCLC治疗中起到了缓解症状、提高生活质量、延长生存期的作用。KPS评分、多器官转移是影响患者预后的独立因素。

OBJECTIVE： To retrospectivly analyze the prognosis palliative radiotherapy for stage IV non-small cell lung cancer and quality of life impact. METHODS： Clinical data of 318 advanced patients of non-small cell lung cancer who received palliative radiation was collected from January 01,2000 to December 30,2009 ,and all the patients refused or can- not receive chemotherapy for all kinds of reasons. 6 MV X-ray accelerator and 60 Co-r treatment machine were used to give the primary tumor and metastases palliative radiotherapy, and some patients received chemotherapy. Survival analysis was performed by the K-M method, comparison among groups was performed by log-rank test and multivariate analysis was carried out with the Cox proportional hazard model. RESULTS： The 1 and 2-year survival rates and median survival time were 25.2%,7.4% and 7 months. The response rate defined as palliation of IV NSCLC symptoms after palliative radio- therapy was 72.4% for cough,80.6% for thoracic pain,88.1% for haemoptysis,60.8% for dyspnoea,19.2% for hoarse- ness. Metastatic bone pain and brain metastases had different signs and symptoms ease or even disappear：76.8% for bone metastases, 75.7 % for brain metastases. Univariate analysis showed KPS, histological type, brain metastases, multi-organ metastasis, primary tumor radiation dose were correlated with prognosis, Multivariate analysis showed KPS and multiple organ metastasis were independently associated with OS. CONCLUSIONS： Palliative radiotherapy in the treatment of stage Ⅳ NSCLC can relieve symptoms,improve quality of life and prolong survival role. KPS,multiple organ metastasis are in- dependent prognostic factors.