目的探讨三维适形放射治疗(3D蛳CRT)对Ⅳ期非小细胞肺癌的疗效及毒副作用。方法采用3D蛳CRT治疗Ⅳ期非小细胞肺癌147例,分为5组:单纯肺转移46例;单纯脑转移26例;单纯肝转移11例;单纯其他脏器转移17例;多脏器转移47例。治疗部分或全部影像学上明确显示的病灶,共设298个靶区,DT□30□Gy～66□Gy,中位分割剂量4□Gy(2□Gy～7□Gy),周剂量10□Gy～16□Gy。结果总1年、2年、3年生存率分别为30.4□%、7.1□%、3.8□%,中位生存时间8个月。单纯肺、脑、肝、其他、多脏器转移组的中位生存期分别为11月、10月、3月、7月、6月。放射性肺炎及放射性肝炎的发生率分别为10.5□%、4.0□%。结论除肺癌肝转移外,利用3D蛳CRT治疗Ⅳ期非小细胞肺癌有较好的疗效,放射反应低。肺癌肝转移患者不宜单纯采用3D蛳CRT治疗。 Objective To investigate the efficacy and side effects of three-dimensional conformal radiotherapy (3D 蛳 CRT) on stage Ⅳ non-small cell lung cancer. Methods 147 cases of stage Ⅳ non-small cell lung cancer were treated with 3D 蛳 CRT and divided into 5 groups: simple lung metastasis in 46 cases, simple brain metastasis in 26 cases, simple liver metastasis in 11 cases, simple other organ metastasis in 17 cases, multiple organ metastasis 47 cases. A total of 298 target sites, DT □ 30 □ Gy ~ 66 □ Gy, and median dose of 4 Gy (2 Gy ~ 7 Gy) were treated for partial or complete imaging of lesions with a weekly dose of 10 □ Gy ~ 16 Gy. Results The overall 1-year, 2-year and 3-year survival rates were 30.4%, 7.1% and 3.8%, respectively. The median survival time was 8 months. The median survival time in simple lung, brain, liver, other and multiple organ metastasis groups was November, October, March, July and June respectively. The incidences of radiation pneumonitis and radiation hepatitis were 10.5% and 4.0%, respectively. Conclusion In addition to liver metastases of lung cancer, the use of 3D 蛳 CRT in the treatment of stage Ⅳ non-small cell lung cancer has a good curative effect and low radiation response. Patients with liver metastases of lung cancer should not be treated with 3D 蛳 CRT alone.