308例非小细胞肺癌放疗效果的临床因素分析

Radiotherapy for 308 patients with non-small cell lung cancer (NSCLC)

目的 探讨非小细胞肺癌单纯放疗的生存情况及影响预后的临床因素。方法 回顾性分析1985年 1月～ 1991年 12月收治的 30 8例非小细胞肺癌 ,Ⅰ期 11例 ,Ⅱ期 6 8例 ,ⅢA期 15 5例 ,ⅢB期 74例。均经病理或细胞学证实 ,采用 10MV X线或CO 6 0机照射 ,常规分割 ,周剂量 7～ 11.5Gy。有 47例放疗开始或半量时按治疗计划布野 ,全程包括纵隔及原发灶 ,纵隔剂量大于 5 6Gy。其它病例纵隔剂量 40Gy。生存率计算采用Kaplan Meier法及Log rank检验。结果 全组中位生存期 10个月 ,1、3、5年生存率分别为 43 %、15 %和9%。影响生存的临床因素分析结果表明 ,临床分期、近期疗效和周剂量与预后有密切关系 (P <0 .0 5 ) ,而放疗总剂量和纵隔剂量与预后未见明显关系 (P >0 .0 5 )。结论 影响肺癌患者放疗预后的临床因素主要是临床分期、近期疗效和周剂量的大小 ,而放疗总剂量和纵隔剂量高低与生存率无明显关系。

Objective To analyze the survival results retrospectively of the patients with NSCLC treated by radiotherapy alone and the clinical factors affecting the survival results. Methods Three hundred and eight patients with NSCLC from January, 1985 to December, 1991 were included in this study (stage Ⅰ, 11 cases; stage Ⅱ, 68 cases; stage ⅢA, 155 cases; stage ⅢB, 74 cases). All patients were confirmed by pathology and cytology. They were treated by 10 MV X ray or cobalt 60, conventionally fractionated, with weekly dose 7 11.5?Gy. In 47 patients of them treatment planning system was used at the beginning or in the middle of radiotherapy as to have the primary lesion and mediastinum in the full course of radiotherapy. In the rest of patients whose mediastinal dose was 40?Gy by anterior and posterior fields, irradiation dose to the spinal cord was avoided and irradiation dose to the primary lesion got to the definitive treatment. The survival rate was analyzed by Kaplan Meier and tested by Log rank. Results The median survival was 10 months. The 1 , 3 and 5 year survival rates were 43%, 15% and 9% respectively. The earlier the clinical stage, the better the prognosis (P= 0.0001) . The survival rate of the patients with complete remission at the end of radiotherapy was better than that of the patients with residual tumor (P=0.0001). The survival of the patients with weekly dose larger than 10?Gy was better ( P=0.0461). There was no relationship among the survival rate and the total dose and mediastinal dose. Conclusion The results show the survival rate of patient with NSCLC treated by radiotherapy alone was related to clinical stage, instant response and weekly dose, but not to the total dose and the mediastinal dose.