Ⅲ期非小细胞肺癌累及野照射的可行性研究

目的探讨Ⅲ期非小细胞肺癌（NSCLC）累及野照射的可行性。方法200例接受三维适形放疗的Ⅲ期NSCLC患者,随机分为2组。累及野照射组（IFI组）仅照射原发灶和短径〉10mm的淋巴结,照射剂量为68～74Gy／7～9w;选择性淋巴结照射组（ENI组）照射野包括原发灶、同侧肺门、隆突下及隆突以上纵隔淋巴引流区,当上纵隔有淋巴结转移时,包括锁骨上淋巴引流区,照射剂量为60～64Gy／6～7．5w。结果IFI组和ENI组的总有效率分别为90．0％和79．0％;放射性肺炎发生率分别为17．0％和29．0％（P=0．04）。1年内原发灶复发率IFI组（13．0％）明显低于ENI组（23．0％）;1年内累及野照射区内淋巴结复发率IFI组为10．0％,ENI组为20．0％（P=0．048）,预防性照射区内淋巴结复发率IFI组为21．0％,ENI组为16．0％（P=0．39）;1、2、3年总生存率,IFI组分别为67．2％、38．7％和27．3％,ENI组分别为59．7％、25．6％和19．2％,其中2年总生存率两组间差异有统计学意义（P=0．048）。结论Ⅲ期NSCLC采用累及野照射,患者耐受性好,预防照射区内淋巴结复发率无增加．通讨照射剂量的提高．有草延长患者的生存期。

Involved-field three-dimensional conformal radiation treatment for stage III non-small-cell lung

OBJECTIVE: To investigate the feasibility of involved-field irradiation (IFI ) for stage III non-small cell lung cancer (NSCLC). METHODS: From September 1997 to November 2001, 200 stage-III NSCLC patients were randomly divided into two groups-- IFI and ENI (elective node irradiation). The IFI group was irradiated by 3DCR to a dose of 68-74 Gy/34-37f/7-9 w including the primary tumor and the lymph nodes of > or = 10 mm in short axis. The ENI group was irradiated to a dose of 60-64 Gy/30-32f/6-7.5 w including the primary tumor, ipsilateral hilum, subcarinal and mediastinal lymph nodes, even the supraclavicular area when the lymph nodes of superior mediastinum were involved. RESULTS: The overall response (CR + PR) rates were 90.0% in IFI group and 79.0% in ENI group. Radiation pneumonitis developed in 29.0% of the patients in ENI group and 17.0% in IFI group (P = 0.04). The 1-year primary tumor failure rate in IFI group (13.0%) was lower than that (23.0%) in ENI group. The 1-year involved nodal failure rate was 20.0% in ENI group and 10.0% in IFI group (P = 0.048). The 1-year elective node failure rate was 16.0% in ENI group versus 21.0% in IFI group (P = 0.39). The 1-, 2-and 3-year overall survival rate was 67.2% , 38.7% , 27.3% , respectively, in IFI group; versus 59.7% , 25.6% , 19.2% in ENI group, with a difference significant in the 2-year overall survival rate between IFI and ENI group (P = 0.048). CONCLUSION: Involved-field 3D-CRT for stage-III non-small cell lung cancer is well tolerated. It does not increase the rate of lymph node failure in the elective node irradiation field, and may improve the survival due to dose escalation.