非小细胞肺癌术后三维适形放疗疗效分析

目的 分析非小细胞肺癌(NSCLC)术后接受三维适形放射治疗(3DCRT)的初步结果.方法 84例NSCLC患者术后接受3DCRT,其中肺叶切除65例(77.4%),全肺切除19例(22.6%);完整的R0切除54例(64.3%),镜下切缘阳性的R1切除15例(17.9%),肉眼残存的R2切除15例(17.9%).术后病理分期为Ⅰ B期1例,ⅡB期7例,ⅢA期52例,ⅢB期24例.全组术后中位放疗剂量为60 Gy(40～70 Gy,2 Gy/次).术后37例患者接受中位3个周期的辅助化疗.中位随访时间为35.5个月.结果 全组患者的3年生存率为58.6%,4年生存率为43.9%.有43例(53.1%)出现复发转移,其中胸内复发8例(9.9%),远处转移38例(46.9%).单因素分析显示,患者性别、年龄、体重下降、肿瘤大小、病理类型和分期与预后无关.接受R1、R2切除的患者预后较差.随访中,有9例(11.1%)患者出现2级以上放射性肺炎.结论 NSCLC患者术后采用3DCRT放疗效果较好,不良反应发生率较低,安全可靠.

Postoperative three-dimensional conformal radiotherapy for resected non-small cell lung cancer

Objective To investigate the association between survival and postoperative three-dimensional conformed radiotherapy (3DCRT) in patients with resected non-small cell lung cancer (NSCLC).Methods Eighty-four patients were treated with surgery and postoperative 3DCRT for NSCLC.Sixty-five (77.4%) patients received lobectomy, and 19 (22.6%) received pneumonectomy.Fifty-four (64.3%) patients achieved R0 resection and 30 cases (35.8%) received R1/R2 resection.Fifty-two patients were of stage Ⅲ A and 24 patients were of stage Ⅲ B.Photon energy of 6 MV was used for all the patients.The median 3DCRT dose was 60 Gy (40-70 Gy) with a fraction size of 2 Gy.Thirty-seven patients received median 3 cycles of adjuvant chemotherapy.The median follow-up was 35.5 months for survivors. Results The overall 3-year survival rate was 58.6%, and the 4-yeer overall survival rate was 43.9%.Of the 43 patients who had treatment failure, only 8 (9.9%) patients showed intrathoracic recurrence, but 38 (46.9%) patients had distant metastasis.The univariate analysis for all patients showed that sex, age, weight loss, tumor size, pathology and stage were not correlated with prognosis.R1/R2 resection was associated with a significantly worse survival.Toxicities were acceptable, with 9 (11.1%) patients appeared higher than NCI CTC grade 2 radiation pneumnonitis.Conclusion In a population-based cohort, postoperative 3DCRT for NSCLC provides a good prognosis, and the radiation-related paeumonitis is acceptable.