Impact of the Gross Tumor Volume and Radiotherapeutic Dose on the Survival of Patients with Locally Advanced Non-small Cell Lung Cancer
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摘要:
目的 探讨肿瘤体积和放疗剂量对接受三维适形放疗的非小细胞肺癌患者长期预后的影响。 方法 对三维适形放疗的87例非小细胞肺癌患者进行分析, 利用三维适形放疗计划系统及CT扫描勾画相应靶区, 分别定义为GTV-P、GTV-N及GTV-T。 结果 全组患者原发肿瘤最大直径 < 5.0 cm者生存率明显高于≥5.0 cm者(χ2=4.29, P=0.000 7);GTV-P < 90.00 cm3者生存率高于≥90.00 cm3者(χ2=4.94, P=0.0262);GTV-T < 100.00 cm3者生存率明显高于≥100.00cm3者(χ2=5.47, P=0.0194), 且GTV-T < 100.00 cm3组患者局控率明显高于≥100.00 cm3者(χ2=6.46, P=0.0110)。剂量≤66Gy组患者中GTV-T < 100.00 cm3亚组预后明显好于≥100.00 cm3亚组(χ2=4.59, P=0.032 2), 而在剂量 > 66 Gy组患者中GTV-T大小对生存率无明显影响。多因素分析结果显示N分期、GTV-T及放疗疗效为影响患者预后独立影响因素。 结论 大体肿瘤体积为预测接受三维适形放疗的非小细胞肺癌患者长期预后的一个可靠指标, 建议在以后接受放疗的非小细胞肺癌患者分析中常规加入该指标; 对体积小的肿瘤行大剂量放疗可能对局部晚期非小细胞肺癌患者生存有益。 Abstract:Objective The present work aimed to investigate the impact of the gross tumor volume(GTV-T) on the long-term survival of non-small cell lung cancer(NSCLC) patients treated with three-dimensional conformal radiotherapy(3D-CRT). Methods A total of 87 patients with inoperable NSCLC were treated with 3D-CRT.The primary tumor volume(GTV-P), nodal volume(GTV-N), and GTV-T were defined by contouring and sketching in multiple sections obtained from the treatment planning system and computed tomography scan. Results The overall survival rates were significantly higher in the NSCLC patients with the largest tumor diameter of < 5.0 cm, GTV-P < 90.00 cm3, and GTV-T < 100.00 cm 3 compared with those with a tumor diameter≥5.0 cm, GTV-P≥90.00 cm3, and GTV-T≥100.00 cm3.The local control rate was significantly higher in patients with GTV-T < 100.00 cm 3 than in those with GTV-T≥100.00 cm3(χ2=6.46, P=0.0110).In the group that received=￡66 Gy, the overall survival rate was significantly higher in the subgroup with GTV-T < 100.00 cm 3 compared with those with GTV-T≥100.00 cm3(χ2=4.59, P=0.0322).In the patients who received a dose > 66 Gy, the GTV-T size did not affect the overall survival.Multivariate analysis showed that the independent variables of the survival included the N-stage, GTV-T, and short-term curative effect. Conclusion The GTV-T is a reliable indicator of the overall survival and local control rates of NSCLC patients who have undergone 3D-CRT treatment.The GTV-T may also be important in the stratification of patients for prospective therapy trials.In future radiotherapeutic trials, patients may need to be stratified by the GTV-T.High-dose radiotherapy may decrease the GTV-T in locally advanced NSCLC. -
Key words:
- Non-small cell lung cancer /
- Gross tumor volume /
- Radiotherapeutic dose /
- Prognosis
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表 1 87例患者T分期与N分期的分布 例
Table 1. T staging of 87 patients and distribution of the N stage
表 2 87例患者T、N分期与GTV-T的分布 例
Table 2. T staging of 87 patients and distribution of the GTV-T
表 3 肿瘤体积与患者预后的单因素分析结果
Table 3. Univariate analysis of tumor volume and patient prognosis
表 4 肿瘤体积与放疗剂量对生存率影响的分层分析
Table 4. Stratification analysis of the effects of tumor volume and radiotherapeutic dose on the survival rate
表 5 Cox模型多因素分析患者预后生存
Table 5. Multivariate analysis of the Cox regression model for prognosis and survival
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