化疗后序贯胸部累及野放疗治疗Ⅳ期非小细胞肺癌临床研究

发布时间：2018-07-05 17:41

本文选题：非小细胞肺癌 + 放疗　；参考：《浙江大学》2017年硕士论文

【摘要】：目的通过对初诊Ⅳ期非小细胞肺癌(NSCLC)行6周期化疗后肿瘤获有效控制序贯行胸部累及野放疗患者的近期疗效、生存期及毒副反应的临床比较研究,评价化疗序贯胸部累及野放疗在Ⅳ期NSCLC临床治疗的有效性和耐受性。方法收集2011年8月-2014年1月在我院完成6周期含铂方案化疗临床评价获肿瘤控制的初诊为Ⅳ期的NSCLC病例82例,所有病例均获细胞学或组织学确诊,采用回顾性病例匹配研究分为治疗组与对照组各42例;对照组:对症支持治疗,必要时行抗肿瘤治疗。治疗组:在对照组治疗方案的基础上行胸部累及野精确放疗。病例随访时间:末次随访至2017年02月16日,84例患者均已死亡,最长随访时间为56个月。统计观察胸部病灶累及野放疗的疗效、两组患者无进展生存期(PFS)、生存时间(OS)、1年生存率、2年生存率、胸部症状发生率、胸部累及野放疗的毒副反应。结果化疗后序贯行胸部病灶累及野精确放疗的患者42例,放疗结束1月CT扫描评估:胸部病灶CR者3例(7.14%),PR者28例(66.67%),SD者9例(21.43%),PD者2例(4.76%),有效率为31/42(73.81%),无效率为 11/42(26.19%)。31 例胸部病灶放疗后获CR或PR的患者中,放疗前胸部原发病灶最大直径3cm有22人,放疗前胸部原发病灶最大直径≥3cm有9人,胸部原发病灶最大直径3cm者更容易达到CR或PR。治疗组与对照组的中位PFS分别为7.1月与4.5月,二者差异有统计学意义(χ2=27.045,P=0.000);治疗组在3个月、6个月、9个月时的PFS率均高于对照组。治疗组与对照组的中位OS分别为22.3月与13.5月,二者差异有统计学意义(χ2=5.908,P=0.015);治疗组在1年、2年时的OS率均高于对照组。治疗组与对照组对比,胸部累及野放疗后3月,治疗组胸部疼痛发生率为16.67%(7/42),对照组胸部疼痛发生率为35.71%(15/42),治疗组胸部疼痛发生率低于对照组,两者差异有统计学意义(χ2=3.941,P=0.047)。治疗组与观察组对比,胸部累及野放疗后3月,治疗组咯血/痰中带血发生率为7.14%(3/42),对照组咯血/痰中带血发生率为26.19%(11/42),治疗组咯血/痰中带血发生率低于对照组,两者差异有统计学意义(χ2=5.4863,P=0.019)。治疗组与对照组对比,胸部累及野放疗后3月,治疗组胸壁侵犯发生率为4.76%(2/42),对照组胸壁侵犯发生率为7.14%(3/42),治疗组胸壁侵犯发生率低于对照组,但两组差异无统计学意义(χ2=0.000,P=1.000)。治疗组发生放射性食管炎29例,其中Ⅰ度25例,Ⅱ度4例,Ⅲ-Ⅳ度0病例;放射性皮炎均为Ⅰ～Ⅱ度,无Ⅲ度及以上病例发生;在放疗25次复查胸部CT平扫及放疗完成后1月复查胸部CT增强发现放射性肺炎31例,其中Ⅰ级25例,Ⅱ级5例,Ⅲ级1例,无Ⅳ级病例,其中2例为有症状性放射性肺炎,2例均住院治疗好转后出院;血液学毒性以白细胞或中性粒细胞减少为主,多为Ⅰ～Ⅱ度,其中8例出现Ⅲ度;无明显心脏毒性反应发生。无放疗相关死亡病例。结论1.胸部累及野放疗能够改善6周期标准化疗后Ⅳ期NSCLC患者的PFS和OS,降低胸痛、咯血/痰中带血的发生率。2.胸部原发病灶局部控制越好的患者越容易得到更好的PFS和OS。3.化疗后序贯胸部累及野放疗治疗Ⅳ期NSCLC的毒副反应可以耐受且安全有效。
[Abstract]:Objective to evaluate the short-term efficacy, survival and side effects of sequential thoracic involvement field radiotherapy for patients with early diagnosis of stage IV non-small cell lung cancer (NSCLC) after 6 cycles of chemotherapy, and to evaluate the effectiveness and tolerance of chemotherapy sequential chest involvement in stage IV NSCLC treatment in 2011. In January -2014 -2014 in January August, the clinical evaluation of platinum regimen chemotherapy was completed in 82 cases of the first diagnosis of tumor control. All cases were diagnosed by cytology or histology. The retrospective case matching study was divided into 42 cases in the treatment group and the control group, and the control group was treated with antitumor treatment. Group: breast and field precise radiotherapy on the basis of the control group. Case follow up time: last follow-up to 16 2017 02 months, 84 patients had died and the longest follow-up time was 56 months. The statistical observation of the effect of chest focus on field radiotherapy, two groups of patients without PFS, survival time (OS), 1 year survival rate, 2 years The survival rate, the incidence of chest symptoms and the toxic and side effects of the chest involving field radiotherapy. Results after chemotherapy, 42 patients with thoracic lesions involving wild precise radiotherapy were performed, and the January CT scan was assessed at the end of radiotherapy: 3 cases (7.14%), 28 cases (66.67%) of PR, 9 (21.43%) of SD, 2 (4.76%) in PD, and 31/42 (73.81%), and the inefficiency of 11/42. (26.19%) in.31 patients with CR or PR after radiotherapy, the maximum diameter of the primary lesion of the chest before radiotherapy was 22. The maximum diameter of the primary focus of the chest before radiotherapy was 9, and the maximum diameter of 3cm in the primary focus of the chest was more likely to be 7.1 months and 4.5 months respectively in the CR or PR. treatment group and the control group, and the two were different. The PFS rate of the treatment group was higher than that of the control group at 3 months, 6 months and 9 months. The median OS of the treatment group and the control group was 22.3 months and 13.5 months respectively. The two differences were statistically significant (x 2=5.908, P=0.015), and the OS rate of the treatment group at 1 years and 2 years was higher than that of the control group. The treatment group was compared with the control group, and the chest was involved in the treatment group. The incidence of chest pain in the treatment group was 16.67% (7/42), and the incidence of chest pain in the control group was 35.71% (15/42). The incidence of chest pain in the treatment group was lower than that of the control group (x 2=3.941, P=0.047). The treatment group was compared with the observation group, and the treatment group was involved in the hemoptysis / Phlegm Blood in the treatment group after the field radiotherapy in March. The rate of hemoptysis in the control group was 7.14% (3/42), and the incidence of hemoptysis in the control group was 26.19% (11/42). The incidence of hemoptysis in the treatment group was lower than that of the control group. The difference was statistically significant (x 2=5.4863, P=0.019). Compared with the control group, the incidence of chest wall invasion in the treatment group was 4.76% (2/42) and the chest wall invasion in the control group was 4.76% (2/42) after the chest involvement in the field radiotherapy. The incidence rate was 7.14% (3/42). The incidence of chest wall invasion in the treatment group was lower than that of the control group, but there was no significant difference between the two groups (x, P=1.000). 29 cases of radioactive esophagitis in the treatment group were found in 25 cases, 4 cases in 4 cases, and 0 degree of grade III to IV degree. After complete CT scan and radiotherapy, 31 cases of radionuclide pneumonia were reviewed in January, including 25 cases of grade I, 5 cases of grade II, 1 cases of grade III, no grade IV cases, 2 cases were symptomatic radiation pneumonia, 2 cases were hospitalized after improvement, and hematological toxicity was mainly white blood cells or neutrophils, mostly I to degree II, 8 cases of which 8 cases were There was no obvious cardiac toxicity. No radiation related death cases. Conclusion 1. thoracic involvement field radiotherapy can improve PFS and OS in stage IV NSCLC patients after 6 cycles of standard chemotherapy, lower chest pain, hemoptysis, and the incidence of blood in phlegm,.2. patients with better local control of chest primary focus are easier to get better PFS and OS.3. After treatment, the chest side field radiotherapy is safe and effective for the treatment of stage IV NSCLC.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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