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目的回顾性分析根治性放疗的非小细胞肺癌(NSCLC)病例,探讨肿瘤局部因素对放疗疗效的影响。方法接受根治性放疗并经病理或细胞学证实的Ⅰ～Ⅲb期NSCLC75例。常规放疗39例,适形放疗36例,总剂量60～70Gy,30～35分次,6～7周完成。由CT扫描测量肿瘤最大直径及体积,对相关指标进行单因素、多因素分析,并用预后指数模型综合评价放疗疗效。结果完全缓解(CR)率33.3%(25/75),有效率(CR+PR)率85.3%(64/75),无变化加病变进展(NC+PD)率14.7%(11/75)。中位生存期13.8个月,1.0、1.5年生存率分别为54.7%、27.5%。单因素及多因素分析显示原发肿瘤直径较小、体积较小、T分期较早、总治疗时间较短和放射性肺炎较轻者预后较好。预后指数能够更敏感地预测放疗疗效。结论原发肿瘤直径、肿瘤体积、T分期、总治疗时间、急性放射性肺炎有可能成为放疗NSCLC的独立影响因素,预后指数模型能够显著提高多指标联合的预测价值。
Objective To retrospectively analyze the cases of non-small cell lung cancer (NSCLC) treated by radical radiotherapy and explore the effect of tumor local factors on radiotherapy. Methods 75 patients with stage Ⅰ ~ Ⅲb NSCLC who underwent radical radiotherapy and were confirmed by pathology or cytology. Routine radiotherapy in 39 cases, conformal radiotherapy in 36 cases, the total dose of 60 ~ 70Gy, 30 ~ 35 times, 6 to 7 weeks to complete. The largest diameter and volume of tumor were measured by CT scanning. Univariate and multivariate analysis were performed on the related indicators. The prognostic index model was used to evaluate the effect of radiotherapy. Results The complete remission (CR) rate was 33.3% (25/75), the effective rate (CR + PR) rate was 85.3% (64/75), and the rate of change without disease progression (NC + PD) was 14.7% (11/75). The median survival time was 13.8 months. The overall survival rates at 1.0 and 1.5 years were 54.7% and 27.5%, respectively. Univariate and multivariate analysis showed that primary tumors were smaller in diameter, smaller in size, earlier in T stage, shorter in total treatment time and less in patients with radiation pneumonitis, had a better prognosis. Prognostic index can be more sensitive to predict radiotherapy. Conclusions Primary tumor diameter, tumor volume, T stage, total treatment time and acute radiation pneumonitis may be independent factors in radiotherapy of NSCLC. Prognostic index model can significantly improve the predictive value of multi-index combination.