单纯放疗和综合放化疗治疗老年局部晚期非小细胞肺癌

目的]评价老年局部晚期非小细胞肺癌接受放疗和放化疗综合治疗结果。方法]分析1999年1月～2004年12月中国医学科学院肿瘤医院收治的105例年龄≥70岁接受放疗和放化综合治疗的老年局部晚期非小细胞肺癌患者。病理分型鳞癌65例，腺癌24例，大细胞癌5例，其他类型11例（分类不明癌）；分期ⅢA43例、ⅢB62例；治疗方法：单纯放疗70例，综合治疗35例，其中同步放化疗7例，序贯化放疗28例。中位放疗剂量60Gy（34～74Gy）。结果]存活病人中位随访17.4个月，中位生存时间为17.1个月，1年生存率65.8%，3年生存率19.8%，5年生存率15.0%。全组72例（68.6%）出现复发转移，其中胸内复发31例（29.5%），远地转移34例（32.4%），7例（6.7%）出现胸内复发及远地转移。单因素分析显示治疗前卡氏评分和放疗剂量显著影响预后。15例（14.3%）患者出现NCICTC≥3级放射性肺炎。放化疗综合治疗组血液毒性反应明显高于单纯放疗组（53.3%vs.7.1%，χ^2=27.0，P〈0.001）结论]老年（≥70岁）局部晚期非小细胞肺癌放射治疗和放化疗综合治疗可获得较好的临床治疗效果，治疗前卡氏评分和放疗剂量与预后有关。

Radiotherapy Alone or Combined Chemoradiotherapy in The Treatment of Elderly Patients with Locally Advanced Non-small Cell Lung Cancer

Purpose] To evaluate treatment outcome of radiotherapy alone or combined chemora- diotherapy in the treatment of elderly patients with locally advanced non-small cell lung cancer. Methods] From January 1999 to December 2004,105 cases elderly patients （≥70 years） with NSCLC in Chinese Academy of Medical Sciences Cancer Hospital received radiotherapy alone or combined chemoradiotherapy. Pathological type： squamous cancer 65 cases, adenocarcinoma cancer 24 cases, large cell carcinoma 5 cases and other types 11 cases;ⅢA stage 43 cases, ⅢB stage 62 cases; 70 cases received radiotherapy alone and 35 cases received combined chemoradiotherapy（7 cases received concurrent chemoradiotherapy, 28 cases received sequential chemoradiotherapy）.The median radiation dose was 60Gy（34-74Gy） and median follow-up period was 17.4 months. Resuhs] Median survival time was 17.1 months. The 1, 3 and 5-year overall survival rates were 65.8%, 19.8% and 15.0% respectively. Recurrence was found in 72 cases（68.6%） of which 31 cases（29.5%） was intrathoracic recurrence, 34 cases（32.4%） was distant metastasis, 7 cases（6.7%） was both intrathoracic recurrence and distant metastasis. Univariate analysis showed that radiation dose and Karnofsky performance status （KPS） were significant impact on prognosis. Fifteen cases （14.3%） appeared NCI CTC ≥ 3 grade radioactive pneumonia. Hemotoxicity in combined chemoradiotherapy group was significantly severer than that in radiation alone group（53.3% vs. 7.1%, Х^2= 27.0,P〈0.001）. Conclusion] Radiation alone or combined chemoradiotherapy can get good survival result for elderly patients with locally advanced non-small cell lung cancer, KPS and radiation dose are related to prognosis.