摘要
目的对75岁以上无远处转移非小细胞肺癌患者单纯放疗和联合放、化疗的疗效进行回顾性分析。方法88例非小细胞肺癌患者分成单纯放疗组(64例)和序贯联合放、化疗组(24例)。单纯放疗组中57例接受常规放疗,4例适形放疗,3例超分割放疗,中位剂量606Gy(200～712Gy)。联合放、化疗组17例接受常规放疗,3例适形放疗,4例超分割放疗,中位剂量598Gy(180～770Gy);并以顺铂为基础联合化疗,中位2疗程(1～6疗程)。结果单纯放疗组的总生存率和肿瘤别生存率与联合放、化疗组相比,两组差异无显著性(均为P>005),但前者4年生存率和肿瘤别生存率分别为19%和23%,两组的肿瘤别中位生存期分别为276个月和211个月,后者无4年生存者。两组的年龄、性别和照射剂量差异无显著性(P>005),但病理类型和临床分期的分布存在明显差异(P<001和P=00546),经Cox比例风险回归模型调整后,联合放、化疗组的肿瘤别死亡风险是单纯放疗组的1193(0576～2470)倍。联合放、化疗组的骨髓抑制比单纯放疗组明显严重,前者白细胞、血红蛋白和血小板中位值明显低于单纯放疗组(42×109/L对56×109/L,P<001;111g/L对127g/L,P<005;154×109/L对214×109/L,P<001)。两组的放射性食道炎和放射性肺炎的发生率差异无显著性(均为P>005)。
Objective To evaluate the effect between radiotherapy alone and combined radio chemotherapy on more than 75 year old patients with M 0 NSCLC by retrospective analysis. Methods Eighty eight cases have been divided into radiotherapy alone group (64 cases) and combined radio chemotherapy group (24 cases). In the former group, 57, 4 and 3 cases received routine, conformal and hyperfraction radiotherapy alone, respectively, with a median dose of 60 6 Gy. In the latter group, 17, 3 and 4 cases received routine, conformal and hyperfraction radiotherapy respectively, with a median dose of 59 8 Gy. All patients received a median 2 cycle(1 6 cycle) of sequential chemotherapy with DDP based regimen. Results There were no markedly differencs in overall survival rate and tumor specific survival rate between two groups ( P= 0 2771, P =0 0727). The 4 year overall survival rate and tumor specific survival rate of radiotherapy alone group were 19% and 23%, respectively. However, in combined radio chemotherapy group, there were no patients lived more than 4 year. The median tumor specific survival time in radiotherapy alone group and combined group was 27 6 monthes and 21 1 monthes, respectively. It showed no difference in the age, sex and given dose between two groups by χ 2 test, but markedly differences in the pathological type and clinical stage between two groups ( P <0 01, P =0 0546). The harzard ratio of tumor specific survival for combined group was 1 193(0 576 2 470) compared to that of the radiotherapy alone group after adjustment of confounding factors by Cox regression model. Bone marrow suppression indicators of the radiotherapy alone group was markedly better than that of combined group 〔leucocyte 4 2×10 9/L vs +5 6×10 9/L(P=0 001),hemoglobin 111 g/L vs 127 g/L(P=0 015),platelet 154×10 9/L vs 214×10 9/L,( P =0 003)〕. The incidence of radiation esophagitis and pneumonitis between two groups showed no differences ( P =0 7609, P =0 3645). Conclusions Radiotherapy alone is a better therapeutic method for the patients over 75 years old with M 0 NSCLC. Added chemotherapy does not enhance the therapeutic effect, adversely, it markedly suppressed the bone marrow function.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2004年第12期848-851,共4页
Chinese Journal of Geriatrics
