Cai Yong, Wang Wen-Lan, Xu Bo, Zhu Guang-Ying, Zhang Shan-Wen
Department of Radiation Oncology, Beijing Cancer Hospital/Institute, School of Oncology, Peking University, Beijing, 100036, P. R. China.
Ai Zheng. 2006 Nov;25(11):1419-22.
BACKGROUND & OBJECTIVE: The patients with stage IV non-small cell lung cancer (NSCLC) usually need radiotherapy and have good responses, particularly in those with brain or bone metastases. This study was to evaluate the influence of radiotherapy on the survival of stage IV NSCLC patients.
Clinical data of 287 patients with stage IV NSCLC were retrospectively analyzed. Whole brain was treated with two parallel fields irradiation; bone metastases were treated with one local field irradiation. Primary tumors, regional lymph nodes and other distant metastases were treated by conventional fractionation radiotherapy or 3-dimensional conformal radiotherapy. Whole brain and bone radiotherapy was delivered with a total dose of 40 Gy in 20 fractions in 4 weeks or with a total dose of 30 Gy in 10 fractions in 2 weeks. The median dose for primary tumors and regional lymph nodes was 50 Gy (20-70 Gy), and the median dose for other distant metastases was 46 Gy (40-60 Gy).
The median survival time of the 287 patients was 9 months (8-10 months). The 1- and 2-year overall survival rates were 30.2% and 8.9%. The median survival time was significantly longer in the patients received chemotherapy than in the patients didn't (10 months vs. 8 months, P = 0.049). In the patients with brain, bone, or other distant metastases, the median survival time was 8, 9, and 10 months, respectively; the 1-year survival rates were 24.8%, 28.7%, and 37.5%, respectively; the 2-year survival rates were 6.7%, 7%, and 15.3%, respectively. By unitivariate analysis, histological type and patients' age were prognostic factors of NSCLC. The median survival time was significantly longer in adenocarcinoma patients than in squamous cell carcinoma patients and other carcinoma patients (10 months vs. 7 and 9 months, P = 0.046), longer in the patients of < or =60 years old than in those of >60 years old (11 months vs. 8 months, P = 0.012), and longer in the patients with only bone metastases than in the patients with concomitant other distant metastases (10 months vs. 6 months, P = 0.033), but there was no significant difference between the patients with only brain metastases and those with concomitant other distant metastases (9 months vs. 8 months, P = 0.374). Radiotherapy for primary tumors and lymph nodes, complications of other chronic diseases, and irradiation dose and pattern had no effect on the survival.
Histological type and patients' age may affect the efficacy of radiotherapy on stage IV NSCLC. The irradiation patterns of 40 Gy in 20 fractions in 4 weeks or 30 Gy in 10 fractions in 2 weeks have no effect on the survival of patients with brain or bone metastases.
IV期非小细胞肺癌（NSCLC）患者通常需要放疗且反应良好，尤其是脑转移或骨转移患者。本研究旨在评估放疗对IV期NSCLC患者生存的影响。
回顾性分析287例IV期NSCLC患者的临床资料。全脑采用两个平行野照射；骨转移采用一个局部野照射。原发肿瘤、区域淋巴结和其他远处转移采用常规分割放疗或三维适形放疗。全脑和骨放疗总剂量为40 Gy，分20次，4周完成，或总剂量为30 Gy，分10次，2周完成。原发肿瘤和区域淋巴结的中位剂量为50 Gy（20 - 70 Gy），其他远处转移的中位剂量为46 Gy（40 - 60 Gy）。
287例患者的中位生存时间为9个月（8 - 10个月）。1年和2年总生存率分别为30.2%和8.9%。接受化疗的患者中位生存时间显著长于未接受化疗的患者（10个月对8个月，P = 0.049）。在脑转移、骨转移或其他远处转移患者中，中位生存时间分别为8、9和10个月；1年生存率分别为24.8%、28.7%和37.5%；2年生存率分别为6.7%、7%和15.3%。单因素分析显示，组织学类型和患者年龄是NSCLC的预后因素。腺癌患者的中位生存时间显著长于鳞状细胞癌患者和其他类型癌患者（10个月对7个月和9个月，P = 0.046），≤60岁患者的中位生存时间长于>60岁患者（11个月对8个月，P = 0.012），仅骨转移患者的中位生存时间长于伴有其他远处转移的患者（10个月对6个月，P = 0.033），但仅脑转移患者与伴有其他远处转移患者之间无显著差异（9个月对8个月，P = 0.374）。原发肿瘤和淋巴结的放疗、其他慢性病并发症以及照射剂量和方式对生存无影响。
组织学类型和患者年龄可能影响放疗对IV期NSCLC的疗效。4周内分20次给予40 Gy或2周内分10次给予30 Gy的照射方式对脑转移或骨转移患者的生存无影响。
