Rengan Ramesh, Rosenzweig Kenneth E, Venkatraman Ennapadam, Koutcher Lawrence A, Fox Jana L, Nayak Reena, Amols Howard, Yorke Ellen, Jackson Andrew, Ling C Clifton, Leibel Steven A
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):741-7. doi: 10.1016/j.ijrobp.2004.04.013.
It has been suggested that larger tumor volume is associated with poor survival in patients with non-small-cell lung cancer (NSCLC). We investigated whether high-dose radiation improved local control in patients with large-volume Stage III NSCLC.
Seventy-two patients with Stage III NSCLC and gross tumor volumes (GTV) of greater than 100 cc were treated with three-dimensional conformal radiotherapy (3D-CRT). Patients were divided into two groups: those treated to less than 64 Gy (37 patients) and those treated to 64 Gy or higher (35 patients).
The 1-year and 2-year local failure rates were 27% and 47%, respectively, for Stage III patients treated to 64 Gy or higher, and 61% and 76%, respectively, for those treated to less than 64 Gy (p = 0.024). The median survival time for patients treated to 64 Gy or higher was 20 months vs. 15 months for those treated to less than 64 Gy (p = 0.068). Multivariate analysis revealed that dose and GTV are predictors of local failure-free survival. A 10 Gy increase in dose resulted in a 36.4% decreased risk of local failure.
Our data suggest that administration of higher doses using 3D-CRT improves local control in Stage III NSCLC patients with large GTVs.
有人提出，在非小细胞肺癌（NSCLC）患者中，较大的肿瘤体积与较差的生存率相关。我们研究了高剂量放疗是否能改善大体积Ⅲ期NSCLC患者的局部控制。
72例Ⅲ期NSCLC且大体肿瘤体积（GTV）大于100 cc的患者接受了三维适形放疗（3D-CRT）。患者分为两组：接受低于64 Gy放疗的患者（37例）和接受64 Gy或更高剂量放疗的患者（35例）。
接受64 Gy或更高剂量放疗的Ⅲ期患者1年和2年局部失败率分别为27%和47%，而接受低于64 Gy放疗的患者分别为61%和76%（p = 0.024）。接受64 Gy或更高剂量放疗的患者中位生存时间为20个月，而接受低于64 Gy放疗的患者为15个月（p = 0.068）。多因素分析显示，剂量和GTV是无局部失败生存的预测因素。剂量增加10 Gy会使局部失败风险降低36.4%。
我们的数据表明，使用3D-CRT给予更高剂量可改善大GTV的Ⅲ期NSCLC患者的局部控制。
