老年早期非小细胞肺癌立体定向放射治疗的疗效及生活质量观察

Observation on curative effect of SBRT and QOL of treated elder patient with early NSCLC

目的:观察分析老年早期周围型非小细胞肺癌(NSCLC)患者立体定向放射治疗(SBRT)疗效和生活质量变化。方法:回顾性分析经射波刀治疗的43例老年早期(I期和Ⅱ期)周围型NSCLC患者的病例资料,治疗给予处方剂量为54~64 Gy,分为3~7次。采用调查问卷的方式分析患者总生存率(OS)、无进展生存率(PFS)和生活质量(Qo L);生活质量评估采用EORTC QLQ-LC43量表。以客观缓解率(ORR)、疾病控制率(DCR)、无局部失败生存率(LFFS)、无区域失败生存率(RFFS)和无远处转移生存率(DMFS)为次要观察指标,肿瘤评价按照完全缓解(CR)、部分缓解(PR)及疾病稳定(SD),同时观察失败模式及不良反应。结果:中位随访35个月(12~56个月),43例患者中CR24例(占55.8%),PR11例(占25.6%),SD4例(占9.3%),PD4例(占9.3%)。肿瘤ORR为81.4%,DCR为90.7%。1年和3年OS、PFS、LFFS、RFFS和DMFS分别为97.6%和86.4%、88.4%和77.7%、92.3%和84.6%、97.6%和97.6%以及92.9%和92.9%。患者的EORTC QLQ-LC43量表各领域标准化评分在治疗前后无差异。常见失败原因为原位复发和远处转移。发生I级放射性肺损伤10例(占23.3%),发生Ⅱ级放射性肺损伤2例(占4.7%),发生I级疲乏14例(占32.6%),出现Ⅱ级血红蛋白下降1例,出现I级胸壁损伤1例,无Ⅲ级及以上的不良反应发生。结论:立体定向放射治疗老年早期NSCLC具有较高的局部控制率、总生存率及无远处转移率,治疗前后生活质量无变化,且不良反应较轻,可作为老年早期NSCLC首选的根治性治疗手段。

Objective： To observe and analyze the changes of curative effect of stereotactic body radiation therapy（SBRT）and the quality of life（QOL） for elder patient with early peripheral non-small cell lung cancer（NSCLC） who received this treatment by using Cyber knife. Methods： The documents of 43 patients with early peripheral NSCLC（I stage and II stage） who underwent treatment of Cyber Knife were enrolled in this research by using retrospective analysis. And the prescription dose was 54-64 Gy, and the times were 3-7 times. And the overall survival（OS）, progress-free survival（PFS） and QOL were analyzed by using questionnaire, and the EORTC QLQ-LC43 scale was adopted to assess QOL. Besides, the objective remission rate（ORR）, disease control rate（DCR）, local failure-free survival（LFFS） rate, regional failure-free survival（RFFS） rate and distant metastasis-free survival（DMFS） rate were used as second observation indexes. And the evaluation of tumor included complete remission（CR）, part of remission（PR） and stabilization of disease（SD）, and the failure mode and adverse reaction were observed at the same time. Results： The results of median follow up 35 months（12 th-56 th month） indicated that there were 24 cases were CR（55.8%）, 11 cases were PR（25.6%）, 4 cases were SD（9.3%） and 4 cases were PD（9.3%） in the 43 cases. And the ORR and DCR of tumor were 81.4% and 90.7%, respectively. And the OS, PFS, LFFS, RFFS and DMFS of one-year and three-year were 97.6% and 86.4%, 88.4% and 77.7%, 92.3% and 84.6%, 97.6% and 97.6%, 92.9% and 92.9%, respectively. The difference of standard score of various field of the EORTC QLQ-LC43 scale between pre and post treatment were no significant. The general failure reasons were recurrence in situ and distant metastasis. There were 10 cases occurred radiation-induced pulmonary injury（Ⅰ grade）（23.3%）, and there were 2 cases occurred radiation-induced pulmonary injury（Ⅲ grade）（4.7%）. And there were 14 cases was fatigue of Ⅰ grade（32.6%）, and only 1 case appeared the decreasing of hemoglobin（Ⅲ grade）, and only 1 case appeared injury of chest wall（Ⅰ grade）. Besides, there was no adverse reaction was above Ⅲ grade or was Ⅲ grade. Conclusion： SBRT has higher local control rate, overall survival rate and it was distant metastasis-free for elder patients with early NSCLC, and QOL of these patients was no difference between pre and post treatment. Besides, its adverse reaction was slight, and it can be used as preferred method for radical surgery of early NSCLC of elder patient.