Ⅲ—Ⅳ期NSCLC同期放化疗后失败模式及寡转移规律探讨

目的 探讨Ⅲ—Ⅳ期NSCLC同期放化疗后寡转移失败规律,思考局部放疗意义。方法 分析2007—2014年229例初治Ⅲ—Ⅳ期NSCLC同期放化疗后寡转移等失败规律。结果299例NSCLC中Ⅲ期治疗失败88例,原发肿瘤复发±远处转移20例(22.7%)、寡转移27例(30.7%),脑转移最多见;Ⅳ期治疗后失败211例,原发肿瘤复发±远处转移11.4%、原转移灶复发10.0%、原转移器官出现新病灶9.0%,寡与非寡转移中原转移灶复发分别为9/94例和12/117例;脑转移发生率最高(38.2%)。结论 Ⅲ期NSCLC寡转移失败近1/3,Ⅳ期仍10%表现为寡转移特征;脑转移是主要失败模式,Ⅳ期NSCLC原发肿瘤根治剂量放疗可降低局部复发失败。

Failure patterns and oligometastasis after concurrent chemoradiotherapy for stage III-IV non-small cell lung cancer

Objective To investigate the failure patterns and oligometastasis after concurrent chemoradiotherapy for stage Ⅲ-Ⅳ non-small cell lung cancer (NSCLC),and to discuss the significance of local radiotherapy.Methods The patterns of failure including oligometastasis were analyzed in 299 previously untreated patients with stage Ⅲ-Ⅳ NSCLC who underwent concurrent chemoradiotherapy from 2007 to 2014.Results Of all the patients with NSCLC,88 patients with stage Ⅲ NSCLC failed,among whom 22(22.7％) experienced primary tumor recurrence with or without distant metastasis and 27(30.7％) experienced oligometastasis,and brain metastasis was the most common failure pattern.A total of 211 patients with stage Ⅳ NSCLC failed,among whom 11.4％ experienced primary tumor recurrence with or without distant metastasis,10.0％ experienced recurrence of the primary metastatic lesions,and 9.0％ experienced new lesions in the organs with metastasis;9 out of 94 patients with oligometastasis and 12 out of 117 patients without oligometastasis,respectively,experienced recurrence of the primary metastatic lesions.Brain metastasis had the highest incidence rate (38.2％).Conclusions After concurrent chemoradiotherapy,nearly 1/3 patients with stage Ⅲ NSCLC and 10％ patients with stage Ⅳ NSCLC experience the failure of oligometastasis,and brain metastasis is the most common pattern of failure.Radical radiotherapy for primary tumors in stage Ⅳ NSCLC can reduce local recurrence.