【摘要】 目的探讨三维适形调强放疗治疗肺转移瘤的疗效、耐受性及预后影响因素。方法选取2014年1月至2015年12月间南充市中心医院收治的86例肺转移瘤患者,均采用三维适形调强放疗。分析患者的近期治疗有效率和耐受性,记录1年和2年总生存率及无进展总生存率,采用Cox风险模型行三维适形调强放疗治疗肺转移瘤预后的单因素和多因素分析。结果患者近期治疗总有效率为82.6%。部分患者出现Ⅰ~Ⅱ度急性放射性肺炎、胸部疼痛、放射性皮炎、白细胞减少和贫血,无Ⅲ~Ⅳ度急性、晚期治疗相关不良反应。患者1年和2年总生存率分别为74.4%和60.5%,1年和2年无进展总生存率分别为43.0%和36.0%。单因素分析显示,肺转移瘤患者预后与功能状态评分(KPS)、转移灶数目、肺转移灶区(GTV)剂量及近期治疗有效率有关,差异有统计学意义(P<0.05);Cox多因素回归分析结果显示,KPS评分、GTV剂量和近期治疗有效率是影响肺转移瘤患者生存的独立预后因素,差异有统计学意义(P<0.05)。结论三维适形调强放疗治疗肺转移瘤,可提高近期治疗有效率,延长生存时间,患者可耐受不良反应,KPS评分、GTV剂量和近期治疗有效率是影响三维适形调强放疗患者预后的独立因素。更多还原

【Abstract】 Objective To discuss the efficacy and tolerance of three-dimensional conformal intensity-modulated radiation therapy( 3 D-CIMRT) for pulmonary metastasis and factors influencing prognosis.Methods Eighty-six patients with pulmonary metastasis treated at Nanchong Central Hospital from January2014 to December 2015 were selected. All the patients underwent 3 D-CIMRT. The short-term treatment effectiveness and patient’s tolerance were analyzed. The 1-year and 2-year overall survival rates and progressfree survival rate were recorded and the Cox risk model was used for univariate and multivariate analyses of the prognosis for pulmonary metastasis after 3 D-CIMRT. Results The overall short-term treatment efficacy was 82. 6%. Some patients were observed to have adverse reactions including grade I ~ II acute radiation pneumonitis,chest pain,radiation dermatitis,leukopenia and anemia without acute or adverse treatment-related adverse reactions. The 1-year and 2-year overall survival rates were 74. 4% and 60. 5%. The 1-year and 2-year overall progression-free survival rates were 43. 0% and 36. 0%. Univariate analysis showed that the prognosis of patients with pulmonary metastasis was related to the Karnofsky performance status( KPS)score,the number of metastases,the dose of gross tumor volume( GTV) and the short-term treatment efficacy( P < 0. 05). Cox multivariate regression analysis showed that the KPS score,the dose of GTV and the short-term treatment efficacy were independent prognostic factors for the survival of patients with pulmonary metastasis( P < 0. 05). Conclusion 3 D-CIMRT can improve the short-term treatment efficacy and prolong the survival time in patients with pulmonary metastasis and the adverse reactions were tolerable. The KPS score,the dose of GTV and short-term treatment efficacy are independent prognostic factors for the prognosis of patients after 3 D-CIMRT.更多还原