【作者】 戴洪海；

【导师】 王绿化；

【作者基本信息】 中国协和医科大学 ， 肿瘤学， 2009， 博士

【摘要】 第一部分:根治性切除ⅢA期-N2非小细胞肺癌的术后放疗目的回顾性研究术后放疗在根治性切除ⅢA期-N2非小细胞肺癌治疗中的作用及影响生存预后的因素。方法2003年1月～2005年12月221例根治性切除术后病理分期为ⅢA期-N2的非小细胞肺癌患者,96例(43.4%)接受了术后放疗,全组共161例(72.9%)接受了辅助化疗。结果全组病例的中位生存时间和1、3、5年生存率分别为为37.9个月、85.5%、51.3%、32.7%。在术后放疗组中位生存时间、1、3、5年生存率分别为43.9个月、94.8%、59.1%、34.3%,在无术后放疗组分别为31.8个月、77.6%、45.4%、30.6%,差异具有统计学显著性(P=0.046),两组间局部区域无复发生存率、无远转生存率和无病生存率的差异均具有统计学显著性。术后放疗对于接受或未接受辅助化疗的病例均可改善生存率。术后采用联合放化疗组生存结果优于接受单一放疗/化疗组,而未接受任何辅助治疗的病例生存结果最差。亚组分析显示临床N2期、鳞癌、T3期和≥4枚阳性淋巴结的病例可从术后放疗中获得生存改善。非肿瘤死亡率在术后放疗组为5.3%,无术后放疗组为6.4%,差异无统计学显著性(p=0.493)。多因素分析显示临床N分期、阳性淋巴结数目百分比、有无术后放疗、有无术后化疗是影响ⅢA期-N2非小细胞肺癌生存的独立因素。结论术后放疗可以改善根治性切除后ⅢA期-N2非小细胞肺癌的生存结果。临床N2期、鳞癌、T3期和≥4枚阳性淋巴结的病例可从术后放疗中获得生存改善,临床N分期、阳性淋巴结数目百分比、术后放疗和术后化疗是影响ⅢA期-N2非小细胞肺癌预后的独立因素。第二部分:非小细胞肺癌的术后放射治疗—三维适形放疗与常规放疗治疗结果比较目的回顾性比较非小细胞肺癌术后三维适形放疗和常规放疗的疗效、失败模式及毒性反应。方法分析自2002年11月～2006年3月接受术后放疗的ⅠB-ⅢB非小细胞肺癌病例患者162例,其中86例采用三维适形放射治疗(Three-Dimensional Conformal Radiotherapy 3DCRT),76例采用常规放疗。3DCRT组和常规放疗组中位随访时间分别为29.4个月和33.8个月。结果3DCRT和常规放疗组两组间局部区域无复发生存率的差异具有显著性(x~2=5.458 P=0.019),两组间总生存率、无病生存率和无远转生存率的差异均不具显著性;总局部区域失败率3DCRT和常规放疗组分别为14.5%和33.3%,差异具有显著性(x~2=7.704 P=0.006),总远地转移率两组间的差异不具备显著性(x~2=0.015 P=0.904)。NCI CTC 2-3级放射性肺炎发生率3DCRT组显著低于常规放疗组(11.6%vs 23.7%x~2=4.102P=0.043)。结论术后放射治疗采用3DCRT技术与常规放疗技术比较能够提高局部控率,降低放疗相关肺毒性反应发生率。更多还原

【Abstract】 PartⅠ:Effect of PORT for completely resceted stageⅢA-N2 non-small cell lung cancerObjective To retrospectively analyze the role of postoperative radiotherapy(PORT) in patients with completely resected stageⅢA-N2 non-small cell lung cancer(NSCLC)and identify the potential prognostic factors.Methods From Jan 2003 to Dec 2005 221 patients with completely resected pathological stageⅢA-N2 NSCLC cancer was analyzed,96 cases received PORT.161 patients(72.9%) were treated with median 4 cycles of adjuvant chemotherapy.Results The median survival time(MST),1-,3- and 5-years overall survival rates(OS) was 43.9 months,94.8%、59.1%、34.3%for PORT group vesus 31.8 months,77.6%,45.4%,30.6%for group without PORT(P=0.046).The difference in the rates of loco-regional relapse-free survival(LRRFS),distant metastasis-free survival(DMFS) and disease-free survival(DFS) between the two groups both reached a statistically significance.Stratified analysis showed survival was improved in patients received PORT,both in the patients with chemotherapy(MST48.3 vs.33.1 months) and without(MST 38.3 vs.21.6 months). Patients received chemoradiotherapy got better survival outcome than patients received either chemotherapy or PORT,those patients without any adjuvant therapy had the worst survival outcome.Subgroups with clinical N2 stage,squamous cell carcinoma types, stage T3,no less than 4 lymph node involved could gain definite survival benefit from PORT.Intercurrent death rate was 5.3%in PORT group and 6.4%in group without PORT(P=0.493).In multivariable Cox proportional hazards models,percentage of involved lymph nodes,clinical N stage,PORT and adjuvant chemotherapy were independent prognostic factors.Conclusions PORT can improve survival in patients with completely resceted stageⅢA-N2 NSCLC.Subgroups with clinical N2 stage, squamous cell carcinoma type,stage T3,no less than 4 lymph node involved can gain definite survival benefit from PORT.clinical N stage,percentage of involved lymph nodes,postoperative radiotherapy and adjuvant chemotherapy were independent prognostic factors. PartⅡ:Postoperative Radiotherapy for Non-Small Cell Lung Cancer: A Comparison of Three-Dimensional Conformal Radiotherapy with Conventional RadiotherapyObjective To evaluate the survival outcome,pattern of failure and therapy-related side effect of postoperative Three-Dimensional Conformal Radiotherapy(3DCRT) and Conventional Radiotherapy in patients with resected non-small-cell lung cancer(NSCLC).Methods 162 patients with stageⅠB-ⅢB NSCLC received postoperative radiotherapy from Nov.2002 to Mar 2006 was restrospetcively analyzed.86 patients received 3DCRT,76 patients receieved conventional radiotherapy among the whole group.The median follow-up was 29.4 months in the 3DCRT group and 24 months in the conventional radiation group.Resulets There was statistically significant difference between 3DCRT group and conventional radiation group in terms of local-regional free survival(χ~2 =5.458 P= 0.019).No statistically significant difference was found in overall survival,disease-flee survival and distant metastasis-free survival between the two group.Statistically significant difference was found in local-regional failure rate between the 3DCRT group and conventional radiation group (14.5%vs 33.3%χ~2 =7.704 P=0.006),No statistically significant difference was found about the incidence of distant metastasis between the two group(χ~2 =0.015 P= 0.904). Pneumonitis for NCI CTC grade 2-3 occured in 10 patients(11.6%) in 3DCRT gourp and 18 patients(23.7%) in conventional radiation group.Incidence of radiation pneumonitis grade 2-3 was Statistically different:among the two group(χ~2= 4.102 P=0.043). Conclusions Postoperative 3DCRT for NSCLC provide a better local-regional control and lower incidence of radiation pneumonitis compared with conventional therapy.更多还原