放射治疗非小细胞肺癌的预后因素分析

目的回顾性分析根治性放射治疗的非小细胞肺癌（ＮＳＣＬＣ）病例,探讨影响放射治疗非小细胞肺癌预后的因素。方法选择１９９０年１月～１９９６年１２月间根治性放射治疗并经病理确诊的Ⅰ～Ⅲｂ期ＮＳＣＬＣ患者２５６例,生存统计采用ＫａｐｌａｎＭｅｉｅｒ法及Ｌｏｇｒａｎｋ检验,多因素分析采用Ｃｏｘ逐步回归模型。以多因素分析时各因素的变异系数乘以分组值计算预后指数。结果全组中位生存时间１４．５个月,１,３,５年生存率分别为６０％,２１％和７％。单因素和多因素分析均显示临床分期早;在较短的总疗程时间内接受较高剂量的照射;病理类型为鳞癌和放射治疗前细胞免疫状态较好的患者预后较好。综合以上４种因素的预后指数模型能够较好地区分不同的预后亚组。结论临床分期、放射治疗方法、病理类型和放射治疗前细胞免疫状态是放射治疗ＮＳＣＬＣ的独立预后因素。预后指数模型能够比ＴＮＭ分期等单个因素更好地反映预后。     

非小细胞肺癌根治术后支气管残端复发的放射治疗

目的探讨非小细胞肺癌根治术后支气管残端复发放射治疗的疗效及毒性反应。方法21例根治术后支气管残端复发的非小细胞肺癌患者行放射治疗,19例采用体外照射,剂量为44~68Gy/22~34次/5~7周。2例行支气管腔内近距离放疗。结果33.3%(7/21)的患者肿瘤完全缓解,42.9%(9/21)的患者肿瘤部分缓解,症状缓解率为81.0%(17/21),中位生存期为22个月,1、3、5年生存率分别为66.7%、26.6%、14.2%,7例患者死于远处转移,10例患者死于局部进展。5例伴有纵隔淋巴结的残端复发癌患者均于治疗后6个月内死亡。结论非小细胞肺癌根治术后支气管残端复发行放射治疗安全有效,毒副反应可以耐受。不伴纵隔淋巴结的患者治疗后有可能长期生存。     

三维适形放射治疗常规外照射后复发的非小细胞肺癌

目的：研究三维适形放射治疗常规放射治疗后复发的非小细胞肺癌可行性，观察近期疗效及早期并发症的发生率。方法：2000年10月至2001年2月，12例非小细胞肺癌疗后复发病例，由美国CMS公司2．6．1三维治疗计划系统设计放射治疗计划，剂量体积直方图（DVH）评价和优化放射治疗计划，体部固定装置及多叶光栏技术实施适形放射治疗。计划靶区为临床所见肿瘤区外放1．0－1．5cm，计划照射剂量为40－60Gy,2.5-3.0Gy/次，1次／d,5d/周。照射方法为固定野、非共面野或旋转弧。计划靶区体积（PTV）中位体积为295cm^3(76.4-512.4cm^3)。按美国放射肿瘤学协作组（RTOG）和世界卫生组织（WHO）标准观察急性放射反应及近期疗效。结果：12例患者均顺利完成治疗。初次放射治疗至再放射治疗的中位间隔时间为19个月（12－32个月），再放射治疗肿瘤中位剂量51．2Gy(42.0-67.5Gy)。近期疗效为完全缓解（CR）8．3％（1／12），部分缓解（PR）66．7％（8／12），无变化（NR）25．0％（3／12），进展（PD）0％（0／12），总有效率为75．0％（9／12）。根据PTOG分级，急性放射性食管炎发生率1－2级16．7％（2／12），3级0％（0／12）；急性放射性肺炎发生率1－2级16．7％（2／12），3级0％（0／12）；骨髓抑制发生率1－2级8．3％（1／12）；3级0％（0／12）；心脏损伤发生率1－2级16．7％（2／12），3级0％（0／12）。12例患者的中位随访期为5个月（3－7个月），随访率为100％。结论：三维适形放射治疗后复发的非小细胞肺癌有较好的近期疗效，早期并发症较低，能为患者耐受，晚期并发症的发生率及远期疗效有待进一步观察。     

早期非小细胞肺癌的放射治疗

在早期非小细胞肺癌(NSCLC)中,有部分患者因各种原因采用单纯放射治疗.多数学者认为,其照射剂量应不低于60Gy.靶区范围的制定,要结合肿瘤的生物学规律和患者的具体情况,体现治疗的个体化.超分割和大剂量分割放射治疗在一定程度上提高了NSCLC的疗效.立体定向放射治疗为早期NSCLC的治疗提供了一种新的治疗手段,初步的临床实践表明是安全、可行的.     

87例非小细胞肺癌根治术后局部复发预后因素分析

[目的]探讨非小细胞肺癌(NSCLC)根治术后局部复发患者的预后影响因素.[方法]回顾性分析87例NSCLC根治术后局部复发患者的临床资料,分析局部复发部位的差异及生存情况.[结果]原发病灶同侧肺残端、肺门、纵隔复发(78.2％)比例远高于对侧肺门、纵隔及双侧锁骨上区(21.8％)(x2=131.713,P=0.000).全组患者复发后中位生存时间21.0个月,1、2、4年累积生存率分别为68.1％、44.5％和12.4％.单因素分析显示:复发间隔时间长、复发后再分期早、放化疗联合治疗以及复发后放疗剂量大于60Gy为预后有利因素,COX模型多因素分析显示仅复发后再分期为独立预后因素.[结论]NSCLC根治术后辅助放疗应以同侧肺门及纵隔为主;对于一般情况较好、复发后再分期早的患者建议放化疗联合治疗并尽可能提高放疗剂量以进一步提高疗效.     

早期非小细胞肺癌的立体定向放射治疗

对早期非小细胞肺癌（NSCLC），立体定向放射治疗（SRT）是一有效的手术替代治疗方法。SRT的疗效和手术结果相当，严重并发症不高，但多数病例治疗后可引起病灶部位纤维变。合适病例为直径〈5cm并且远离食管、气管或主支气管的病灶，生物等效剂量应达到100Gy为宜。     

非小细胞肺癌三维适形放射治疗临床研究

 目的 比较三维适形放射治疗（3DCRT）和立体定向放射治疗（SRT）圆形准直器系统治疗非小细胞肺癌（ NSCLC）的临床疗效。方法 64例NSCLC患者随机分为治疗组（3DCRT组）和对照组（SRT组），均常规放射治疗40 Gy后，再分别应用3DCRT和SRT加量照射，两组均为4～5 Gy／次，6～7次，隔日1次，每周3次，总量28～35 Gy，2～3周完成。结果 3DCRT组和SRT组有效率分别为87.9 ％和64.5 ％，差异有统计学意义；3DCRT组和SRT组1、2、3年生存率分别为74.6 ％、51.5％、36.2 ％和71.2 ％、48.9 ％、26.5 ％。中位生存时间分别为23和18个月，差异均无统计学意义；3DCRT组和SRT组正常组织并发症发生率（NTCP）分别为27.3 ％和48.4 ％，差异有统计学意义。结论 3DCRT可有效提高NSCLC患者肿瘤局部控制率和生存质量。     

非小细胞肺癌的后程适形放疗疗效

目的探讨后程适形放疗在非小细胞肺癌治疗中的临床价值.方法回顾分析我院1999年后程适形放疗的非小细胞肺癌患者19例.对比同期本院非小细胞肺癌患者常规放疗25例.对后程适形放疗组(1ate course conformal radiotherapy,LCCR)和常规放疗组(conventional radiotherapy,CR)进行比较.结果完全缓解率(CR)和总有效率(CR+PR)LCCR组为31.6%和89.5%;CR组为8%和60%.两组有显著性差异(P＜0.05).12月生存率、局部控制率LCCR组为78.9%、68.4%,18月生存率、局部控制率LCCR组为63.2%、47.4%.CR组分别为48%、24%和32%、16%.两组差异有显著性意义.放射性食管炎、放射性气管炎、放射性肺炎及放射性肺纤维化2个组均无差异.结论后程适形放疗治疗非小细胞肺癌患者的放射毒性反应与常规放疗相似,但疗效优于常规放疗.     

Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer

BACKGROUND:

This study assessed the impact of surgical, histopathologic and patient‐related factors on the risks of local and distant recurrence and overall survival for patients with stages I through IIIA nonsmall cell lung carcinoma (NSCLC) undergoing definitive resection with or without adjuvant chemotherapy.

METHODS:

This study included 373 consecutive patients treated between 2000 and 2005 who did not receive adjuvant or neoadjuvant radiotherapy, had at least 3 months of follow‐up, and did not have a history of other cancers within 5 years of the diagnosis of their NSCLC. Of these, 52% had pathologic stage IA disease, 30% had stage IB, 5% had stage IIA, 8% had stage IIB and 5% had stage III disease. Forty‐four patients received chemotherapy.

RESULTS:

The median follow‐up was 33 months. Local failure rates at 2 years, 3 years, and 5 years were 16%, 22%, and 32%, respectively; distant recurrence rates were 13%, 15%, and 21%, respectively. Multivariable analysis revealed that local recurrence was significantly associated with the presence of lymphatic or vascular invasion (LVI), the use of chemotherapy, and having diabetes; distant recurrence was significantly higher in patients with nonsquamous cell histology, those undergoing pneumonectomy, and those with more advanced TNM stage. Survival was significantly associated with age, history of myocardial infarction, performance of a pneumonectomy, histology, LVI, and the number of positive N1 lymph nodes.

CONCLUSIONS:

Local recurrence was the predominant type of failure in this series. Patient with diabetes or LVI may benefit from close surveillance and aggressive therapy of asymptomatic local recurrences, especially when chemotherapy is given in addition to surgery. Cancer 2009. © 2009 American Cancer Society.     

女性肺癌的血管生成和血管内皮生长因子的表达研究

目的 研究女性非小细胞性肺癌（ＮＳＣＬＣ）中微血管密度（ＰＭＶＤ）和血管内皮生长因子（ＶＥＧＦ）的表达,并分析其与病理分期,组织类型间的关系。方法 应用免疫组织化学技术,检测了４０例女性ＮＳＣＬＣ外科手术标本中ＭＶＤ和ＶＥＧＦ表达。其中鳞癌７例,混合型鳞腺癌６例,外科病理分期为Ｉ期１３例,Ⅱ－Ⅲ期２７例。结果 （１）３７例女性ＮＳＣＬＣ中ＶＥＧＦ阳性率平均为７８．４％,其中１期病例的阳性率为５８．     

Recent developments in the chemotherapeutic options for nonsmall cell lung cancer

Lung cancer is one of the leading causes of cancer deaths in the developed world. It is grossly divided into small cell and nonsmall cell types. Depending on the stage at diagnosis, the principal means of treating nonsmall cell lung cancer are surgery, chemotherapy and/or radiotherapy. However, even when it is diagnosed at an early stage, the progression-free and overall survival rates have been disappointing compared with other cancers. In recent years, there have been a number of developments in the chemotherapeutic options for nonsmall cell lung cancer. The aim of this review is to summarize these developments, in a stage-specific manner, with respect to both standard chemotherapy and also the newer targeted therapies.     

Expression of multiple epigenetically regulated cancer/germline genes in nonsmall cell lung cancer

Cancer/germline (CG) antigens represent promising targets for widely applicable mono- and multiantigen cancer vaccines for nonsmall cell lung cancer (NSCLC). Since little is known about their composite expression in this tumor type, we analyzed 7 CG genes (MAGE-A3, NY-ESO-1, LAGE-1, BRDT, HOM-TES-85, TPX-1 and LDHC) in 102 human NSCLC specimens. About 81% of NSCLC express at least 1 and half of the specimen at least 2 CG genes. Activation of most of these genes occurs more frequently in squamous cell cancer than in adenocarcinomas. Even though we found all genes but one to be regulated by genomic methylation, not all of them are co-expressed. In particular, combining CG genes not localized on the X-chromosome may provide effective treatment for an extended number of patients.     

非小细胞肺癌的减量性手术治疗

目的探讨非小细胞肺癌减量性手术的疗效和影响因素。方法用ＳＰＳＳ统计软件包的Ｋａｐｌａｎ－Ｍｅｉｅｒ和Ｃｏｘ模型,分析比较２４４例肺癌减量术及同期３６４例剖胸探查术的累积生存率和影响生存率因素。结果非小细胞肺癌减量术的１,３,５年累积生存率分别为５６．９％、２０．６％和１７．５％;探查术为４１．１％、７．８％和５．３％。两者比较,Ｂｒｅｓｌｏｗ＝２７．５５,Ｐ＜０．０００１。多因素分析显示,影响生存的主要因素为手术性质（减量术或探查术,Ｂ＝－０．４６００,Ｐ＜０．０００１）和有否后续治疗（Ｂ＝－０．１０５９,Ｐ＝０．０２１６）。结论肿瘤减量性手术是Ⅲ、Ⅳ期非小细胞肺癌的重要治疗手段之一,术后行放疗、化疗能有效地提高患者的生存率。     

168例Ⅰ和Ⅱ期非小细胞肺癌放射治疗疗效观察

目的　探讨Ⅰ和Ⅱ期非小细胞肺癌单纯放射治疗的疗效及预后因素。方法　 16 8例中鳞癌 94例 ,腺癌 19例 ,鳞腺混合癌 3例 ,癌未分型 5 2例。放射治疗采用60 Co或 10MVX射线常规外照射 ,剂量为 4 0～ 76Gy。用Kaplan Meier法和Logrank法分析比较生存率 ,用Cox进行多因素回归分析。结果　放射治疗剂量≥ 6 5Gy组放射治疗结束时X射线片显示治疗有效 (CR +PR)率明显高于 <6 5Gy组 (χ2 =4 .4 2 ,P =0 .0 4 )。中位生存时间 2 2个月 ,总 1、3、5年生存率分别为 6 7.6 %、2 8.0 %、15 .7%。Cox回归模型分析显示放射治疗前患者是否伴有其他内科疾病及卡氏评分是影响患者预后的独立因素。结论　对于放弃手术治疗的早期非小细胞肺癌 ,放射治疗仍是一种有效的治疗手段。经选择的部分病例放射治疗剂量有必要达到 6 5Gy ,从而提高肿瘤局部控制率和患者生存率。     

Definitive radiotherapy for stage I nonsmall cell lung cancer

BACKGROUND:

The current study characterizes the overall survival (OS) and cause‐specific survival (CSS) of patients with stage I nonsmall cell lung cancer (NSCLC) who were treated with radiotherapy alone, and analyzes the variables potentially affecting survival outcomes.

METHODS:

A total of 8524 patients with stage I NSCLC (according to the sixth edition of the American Joint Committee on Cancer staging manual) who were diagnosed between 1988 and 2008 were retrospectively analyzed using the population‐based Surveillance, Epidemiology, and End Results database. Cox regression analysis was used to calculate hazard ratios (HR) from multivariate analyses.

RESULTS:

The 1‐year, 2‐year, and 5‐year OS rates were 62%, 37%, and 11%, respectively; the corresponding lung cancer CSS survival rates were 68%, 45%, and 20%, respectively. Approximately 77% of deaths were from lung cancer (5292 of 6891 total deaths). Cardiac (n = 477 deaths) and pulmonary (other than lung cancer deaths; n = 475 deaths) deaths accounted for 14% of deaths. From Cox proportional hazards analyses, male sex (HR, 1.2) and squamous cell carcinoma histology (HR, > 1.1) were found to be significantly (P < .0001) adverse prognostic factors for both OS and lung cancer CSS. A more recent calendar year of diagnosis was associated with significantly (P < .0001) improved OS (HR, 0.84 per decade) and lung cancer CSS. This trend was also significant (P < 0.0001) when restricting analyses to those patients with tumors measuring ≤ 5 cm (n = 5402 patients). T1 classification (vs T2 or T unknown) and smaller tumor size were found to be significantly (P < .0001) favorable factors.

CONCLUSIONS:

From a population‐based registry analysis of patients with stage I NSCLC, significant (albeit modest) improvements in survival in more recent years were appreciated, which likely reflect technologic advances in the diagnosis of, staging of, and radiotherapy for NSCLC. Cancer 2012. © 2012 American Cancer Society.     

食管癌根治术后吻合口复发的放射治疗

探讨食管癌根治术后吻合口复发放射治疗的价值。方法　病理确诊为食管癌且术后病理切缘阴性的 6 1例患者根治术后吻合口复发 ,复发时间在术后 3～ 16 1个月 ,中位时间 16个月。单纯吻合口复发 2 7例 ,吻合口复发伴纵隔淋巴结转移 34例。 46例在吻合口复发后接受放射治疗 (放射治疗组 ) ,10例化疗及 5例未治为非放射治疗组。结果　手术后 1、3、5年总生存率分别为88.5 %、31.2 %、19.7% ;复发后 1、3、5年生存率分别为 2 6 .3 %、3 .2 8%、1.6 4%。 >1年复发后的手术后 5年总生存率分别为 0 .0 %、31.4% (P <0 .0 1) ;5年复发后生存率分别为 0 .0 %、8.9% (P =0 .0 4)。单纯吻合口复发手术后 5年总生存率为 33 .3 % ,吻合口复发 纵隔淋巴结转移手术后 5年总生存率为 5 .9% (P =0 .0 7)。放射治疗组的手术后 5年总生存率为 2 1.7% ,而非放射治疗组则为6 .7% (P =0 .0 2 ) ,且放射治疗组的复发后 1年生存率为 2 8.3% ,而非放射治疗组则为 0 .0 % (P <0 .0 1)。结论　手术后吻合口复发时间及是否接受放射治疗是影响预后的主要因素 ,单纯吻合口复发者的预后优于吻合口复发合并纵隔淋巴结转移者。