伴骨转移的非小细胞肺癌化疗同期三维放疗预后分析

目的 探讨非小细胞肺癌(NSCLC)骨转移的胸部原发灶三维放疗在综合治疗中的作用。方法 选取2003-2010年间伴骨转移的95例Ⅳ期NSCLC化疗≥2周期且同期胸部三维放疗的前瞻性研究资料，其中47例单纯骨转移、48例合并其他脏器转移。Kaplan-Meier法计算生存率，Logrank法组间比较及单因素预后分析，Cox模型行多因素预后分析。结果 随访率95%。1、2、3年生存率分别为44%、17%、9%。单因素分析显示原发灶计划靶体积放疗剂量≥63 Gy、原发肿瘤治疗有效和化疗≥4周期者生存延长(P=0.001、0.037、0.009)。单纯骨转移和合并其它转移患者分别进行分析，原发灶计划靶体积放疗剂量≥63 Gy仍是影响其生存的因素(P=0.045、0.012)。单纯骨转移患者原发肿瘤分期T₁+T₂期较T₃+T₄期患者生存延长(P=0.048)。多因素分析显示原发灶计划靶体积放疗剂量≥63 Gy和单纯骨转移能延长总生存(P=0.036、0.035)。结论 NSCLC骨转移胸部原发灶三维放疗技术及剂量在综合治疗中对改善生存具有重要作用。

Prognostic analysis of chemotherapy with concurrent three-dimensional radiotherapy in non-small cell lung cancer patients with bone metastases

Objective To investigate the role of three-dimensional (3D) radiotherapy to the thoracic primary tumor in non-small cell lung cancer (NSCLC) patients with bone metastases during chemotherapy with concurrent 3D radiotherapy. Methods From 2003 to 2010, the clinical data of 95 stage Ⅳ NSCLC patients with bone metastases were collected. All patients received 3D radiotherapy to the thoracic primary tumor and at least 2 cycles of chemotherapy. Of the 95 patients, 47 had only bone metastases, and 48 had metastases to bones and other organs. The Kaplan-Meier method was used to calculate overall survival (OS) rates. The log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results The follow-up rate was 95%. The 1-, 2-, and 3-year OS rates were 44%, 17%, and 9%, respectively. The univariate analysis showed that radiation dose to the planning target volume (PTV) of primary tumor of ≥63 Gy, response to treatment of primary tumor, and at least 4 cycles of chemotherapy were favorable prognostic factors for OS in all patients (P=0.001, 0.037, and 0.009). Radiation dose to the PTV of primary tumor of ≥63 Gy remained the favorable prognostic factor for OS in patients with only bone metastases and those with metastases to bones and other organs (P=0.045 and 0.012). Among patients with only bone metastases, those with T₁+T₂ primary tumors had longer OS than those with T₃+T₄ primary tumors (P=0.048). The multivariate analysis showed that radiation dose to the PTV of primary tumor of ≥63 Gy and metastases to bones only were independent favorable prognostic factors for OS in all patients (P=0.036 and 0.035). Conclusions For NSCLC patients with bone metastases, 3D radiotherapy to the thoracic primary tumor and its dose play an important role in improving OS during chemotherapy with concurrent 3D radiotherapy.