常规设野与累及野照射局部晚期非小细胞癌的临床研究

【摘要】 ［目的］探讨局部晚期肺癌的放疗范围。［方法］87例局部晚期肺癌随机分为累及野组和常规野组,两组其他特征相似。［结果］全组中位生存时间12.00个月；1、2年总生存率分别为58.71%，17.93%,常规野组和累及野组疗效相似,1、2年生存率分别为59.31%,17.85%和57.86%,18.30%.(P0.05), 中位生存时间分别为12.14月和11.87月。常规野组和累及野组的治疗失败原因为病灶局部、远处转移、区域复发,分别为75.86%、55.17%、3.45% 和70.27%、56.76%、5.40% (P0.05)。常规野放射性肺炎的发生率Ⅰ～Ⅱ级32.5%,Ⅱ～Ⅲ级15.00%,累及野组Ⅰ～Ⅱ级27.66%,Ⅱ～Ⅲ级14.89%.常规野组Ⅳ级放射性肺炎2例。［结论］部晚期肺癌给予常规野(预防淋巴结区)和累及野放疗, 预后无明显改善,累及野可减轻放射性肺炎程度,建议累及野照射。

【关键词】 非小细胞肺癌; 放射治疗;照射野; 区域淋巴结。

Abstract: ［Objective］To study the optional field of radiotherapy for patients with locally advanced nonsmall cell lung cancer(NSCLC) by analysis of recurrence patterns when elective lyunph node irradiation was omitted.［Methods］87 patients with locally advanced NSCLC,were divided into two groups.［Results］All patients completed the treatment with a response rate of 80.00% and 78.82% in conventional field group and involved field group,respectively.Ⅰ～Ⅱ,Ⅱ～Ⅲgrade of pneumonia observed in conventioual field group was 32.5%,20% versus 27.66%,14.89%,respectively,in involved field group.Two of those patients in conventional field group had Ⅳ grade pneumonia.The overall survival rate of 1and 2year was 58.71% and 17.93%,respectively,with median survival time of 12.00 months.The 1and 2year survived rale in patients with conventional field group andinvelved field gvoup.was 59.31%,17.85and 57.86%,18.30%(P0.05) with median survival time of 12.14 onouths and 11.87 months, respectivelly.The difference between the two radiotherapy was no significant(P0.05).Infield recurences,distant recurrences and reginal recurrences developed in conventional field group 75.86%,55.17%,3.45%,versus 70.27%,56.76%,5.40%.［Conclusion］Omitting elective lymph node irradiation did not cause a significant amount of failure in lymph node region involved in the clinical target volune, involved field iradiation did not reduce the survival.Therefore,we suggest involed field irradiation in patients with NSCLC.

Key words:NSCLC；radiotherapy;irradiation field size；elective lymph node region 　　我国原发性肺癌的发病率明显上升,已成为恶性肿瘤的首位死因。其中,非小细胞肺癌(Nonsmall cell lungcancer,NSCLC)的发病率占肺癌总数的75%～80%［1］。不可手术的中晚、晚期肺癌占了大多数,内约半数为局部广泛期的ⅢA、ⅢB期,其主要治疗方法为放疗。但对于放疗靶区的大小至今尚没有统一。

1 资料 　　2001年9月至2005年8月间,我科收治的87例局部晚期NSCLC患者,采用前瞻性非随机对照的方法分为两组。常规野组40例(男23例,女17例。年龄（45～75岁)累及组47例(男25例,女22例,年龄（41～80岁)。两组患者的临床特征比较（P＞0.05）。