Ⅳ期寡转移NSCLC放疗及最佳介入时机研究

The clinical study of chest radiotherapy and optimal timing of intervention in oligometastatic stage Ⅳ NSCLC

目的 明确胸部放疗在Ⅳ期寡转移NSCLC治疗中的意义,探索胸部放疗最佳介入时机。方法 将2008-2014年山西省肿瘤医院192例Ⅳ期“寡转移”NSCLC患者随机均分为单纯化疗组、放疗早期介入组、放疗中期介入组、放疗晚期介入组。Kanplan-Meier法生存分析。结果 192例寡转移Ⅳ期NSCLC中位生存期为14.50个月,1、2、3年生存率分别为57.4%、24.0%、10.7%。单纯化疗组、放疗早期介入组、放疗中期介入组、放疗晚期介入组中位生存期分别为10、21、18、13个月,1年生存率分别为34%、73%、71%、51%,2年生存率分别为10%、40%、32%、13%,3年生存率分别为0%、24%、16%、3%（P=0.000）。放疗剂量≥60 Gy与〈60 Gy者的中位生存期分别为21个月与13个月,1年生存率分别为76%与53%,2年生存率分别为34%与21%,3年生存率为17%与10%（P=0.002）。结论 对于Ⅳ期寡转移NSCLC患者,胸部病灶放疗的较早期介入和高剂量放疗能提高患者局控率,延长生存期。

Objective To clarify the significance of chest radiotherapy in the treatment of oligometastatic stage Ⅳ non-small cell lung cancer （NSCLC） and to explore the optimal time of interventional therapy during chest radiotherapy. Methods A total of 192 patients with oligometastatic stage Ⅳ NSCLC admitted to Shanxi Provincial Cancer Hospital from 2008 to 2014 were randomly and evenly divided into the chemotherapy alone, radiotherapy＋ early intervention, radiotherapy＋ middle intervention and radiotherapy＋ late intervention groups. Survival analysis was performed with Kanplan-Meier method. Results The median survival of 192 patients with oligometastatic stage Ⅳ NSCLC was 14.50 months, and the 1-,2-and 3-year survival rates were 57.4%,24.0% and 10.7%, respectively. The median survivalin the chemotherapy alone, radiotherapy＋ early intervention, radiotherapy＋ middle intervention and radiotherapy＋ late intervention groups was 10,21,18 and 13 months, respectively. The 1-year survival rates were 34%,73%,71% and 51%,10%,40%,32% and 13% for the 2-year survival rates, and 0%,24%,16% and 3% for the 3-year survival rates （P=0.000）.The median survival of patients with radiotherapy dose ≥ 60 Gy and〈 60 Gy was 21 and 13 months, 76% and 53% for the 1-year survival rates, 34% and 21% for the 2-year survival rates, and 17% and 10% for the 3-year survival rates （P=0.002）. Conclusion Early interventional therapy and high-dose radiotherapy can improve the local control rate and prolong the survival time of patients with oligometastatic stage Ⅳ NSCLC.