三维适形大分割放射治疗局部中晚期非小细胞肺癌的不良反应与长期生存分析

目的比较大分割与常规分割三维适形放射治疗局部晚期非小细胞肺癌的长期生存疗效及不良反应，并分析影响预后的因素。方法对我院自2000年1月至2004年1月收治行大分割放射治疗的75例和同期行常规分割放疗的83例非小细胞肺癌患者进行分析。放疗后3月内参照RECIST标准评价近期疗效，并对患者的急慢性放射损伤进行分级和评价，随访至2009年12月31日，计算1、3、5年生存期和生存率。采用SPSS11.5统计软件进行统计分析。结果两组患者各组变量均衡，全组患者1、3、5年生存率为44.9%、19.0%及11.7%；两组患者生存率比较差异未见统计学意义(χ²=3.33，P=0.068)。全组患者1、3、5年局部控制率为76.8%、48.1%及40.5%；两组患者局部控制率差异有统计学意义(χ²=3.80，P=0.041)。肿瘤最大直径、是否化疗、治疗时间、近期疗效为患者预后的独立影响因素。大分割放疗组与常规分割放疗组患者相比，前者治疗天数显著低于后者(χ²=3.93，P=0.047)，近期疗效亦显著好于后者(χ²=9.649，P=0.022)，两组患者2级以上放射性肺和食管损伤差异均无统计学意义。结论非小细胞肺癌的大分割放射治疗有较好的远期疗效，患者治疗时间减少，不良反应未见明显增加。

Toxic Effect and Long-term Survival of Three Dimensional Conformal High-dose Radiotherapy for Non-small Cell Lung Cancer

Objective To compare the long term survival and side effects of the high-dose radiotherapy with the convention radiotherapy for locally advanced non-small cell lung cancer(NSCLC),and to analysis the prognostic factors.Methods From Jan,2000 to Jan,2004,75 patients underwent high-dose radiotherapy(HRT) and 83 patients received conventional radiotherapy(CRT) in non-small cell lung cancer were analyzed.The clinical evaluation of the patients in the recent 3 months after radiotherapy were carried out according RECIST criteria.The toxicity reaction to the patients were graded.SPSS11.5 software was used for statistical analysis.Results The two groups had the same variable.For all patients,the overall response rate(CR + PR) was 80.4%,and the 1-,3-and 5-year survival rates were 44.9 %,19.0%and 11.7%,respectively.There were no statistics significance between HRT group and CRT group.For all patients,the 1-,3-and 5-years local control rate was 76.8%,48.1% and 40.5%,respectively.There were statistics significance between HRT group and CRT group(χ2=3.80,P=0.041).The multivariate analysis showed that the maximum diameter of tumor,chemotherapy,treatment time and short-term curative effect were independent prognostic factors.Compared HRT group with CRT group,the treatment time was shorter(χ2=3.93,P=0.047),and the short-term curative effect was better(χ2=9.649,P=0.022).But,there were no statistics significance between the two groups in the rate of radiation injury.ConclusionThe high-dose radiotherapy has a good long effective in the treatment of NSCLC.The treatment time was shorter and the side effects were not more.