三维适形放疗联合EGFR-TKIs治疗局部晚期非小细胞肺癌效果观察

摘要

目的 评价放疗联合靶向治疗对局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的效果.方法 回顾分析91例局部晚期NSCLC患者的临床资料,病理均经组织学或细胞学证实,行三维适形放疗或调强放疗,常规分割每次1.8～2.0 Gy,每日1次,每周5次,计划靶体积剂量56～64 Gy.其中单纯放疗39例,同时口服靶向药物52例,对可能影响预后的相关指标进行单因素和多因素分析.结果 所有患者1、2、3年生存率分别为63.4％、33.8％、17.0％,中位生存期为19.4个月.Log-Rank单因素分析显示:鳞癌较腺癌无进展生存期和总生存期长、肿瘤靶区体积(gross target volume,GTV)≤250 cm3者较GTV＞250 cm3者无进展生存期和总生存期长、照射剂量＞60 Gy者较≤60 Gy者无进展生存期和总生存期长、表皮生长因子受体突变阳性者较野生型者无进展生存期和总生存期长、接受靶向治疗者较不接受靶向治疗者无进展生存期和总生存期长、疗效越好无进展生存期和总生存期越长,差异有统计学意义(P＜0.05).Cox回归多因素分析显示:照射剂量、靶向治疗、疗效评价是影响NSCLC患者生存率的因素(P＜0.05).结论 放疗照射剂量、靶向治疗及疗效判定是局部晚期NSCLC的预后因素,放疗联合靶向治疗是局部晚期NSCLC的有效方法.%Objective To evaluate the effect of radiotherapy combined targeted therapy.Methods A retrospective analysis was performed on the medical records of 91 cases with locally advanced non-small cell lung cancer(NSCLC).The pathology was confirmed via histology and cytology,using three dimensional conformal radiation therapy or intensity-modulated radiation therapy,with 1.8-2.0 Gy per fraction once a day,five times a week and planning target volume 56-64 Gy.Thirty-nine received radiotherapy alone.And 52 received radiotherapy combined with erlotinib.The Kaplan-Meier method was used to calculate overall survival rate.The Cox regression model was used for multivariate prognostic analysis.Results For all the patients,the survival rate of one,two and three years were 63.4％,33.8％,and 17.0％ respectively,and the median survival time was 19.4 months.Univariate analysis by Log-rank test showed that the progress free survival and overall survival time varied significantly among lung cancer patients from different pathology type,gross target volume (GTV),irradiation dose and epidermal growth factor rececptor(EGFR) mutation or non-mutation and receiving target therapy or non-receiving target therapy(P＜0.05),according to this research it indicated that lung cancer patient with squamous cell carcinoma,GTV less than 250 cm3,irradiation dose more than 60 Gy,EGFR mutation and receiving target therapy could survive a longer progress free survival and overall survival.Multiple factors analysis of Cox regression model suggested radiation dose,targeted therapy,the curative effect were the main factors for patients' survival time(P＜0.05).Conclusion Radiation dose,target treatment and curative effect were prognostic factors of locally advanced NSCLC.Radiotherapy combined targeted therapy was an effective method for locally advanced NSCLC.