摘要目的 评价Ⅲ期NSCLC的3DCRT疗效以及预后相关因素.方法 2000-2010年接受3DCRT的NSCLC患者474例,其中男382例、女92例,中位年龄63岁;ⅢA期211例、ⅢB期263例.单纯放疗165例、放疗+化疗者309例;采用常规放疗+3DCRT、3DCRT、IMRT者分别为55、340、79例,中位等效剂量60(44～77) Gy.Kapian-Meier法计算生存率,Logrank法单因素分析,Cox模型多因素分析.结果 随访率96.6％;全组1、3、5年OS率分别为63.0％、24.9％、17.8％,中位生存期18个月.单因素分析显示性别、年龄、近期疗效、放疗方式、分割方式、化疗与否、RP为预后因素(P=0.004、0.001、0.000、0.007、0.004、0.009、0.049);多因素分析显示性别、年龄、近期疗效、放疗方式、RP为预后因素(P=0.006、0.000、0.000、0.003、0.048),其中放疗剂量60～66Gy者预后最好.结论 Ⅲ期NSCLC的3DCRT疗效表明女性、低年龄组、近期疗效好、全程3DCRT、0-1级RP者预后好,反之预后差;3DCRT联合化疗有生存获益,放疗剂量以60～66Gy为宜.

abstractsObjective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC).Methods From 2000 to 2010,474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects.Those patients,consisting of 382 males and 92 females,had a median age of 63 years.In those patients,211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT,340 with 3DCRT,and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method,log-rank test,and Cox model were used for survival rate calculation,univariate analysis,and multivariate analysis,respectively.Results The follow-up rate was 96.6％.In all patients,the 1-,3-,and 5-year overall survival rates were 63.0％,24.9％,and 17.8％,respectively;the median survival time was 18 months.The univariate analysis showed that sex,age,immediate response,radiotherapy method,fractionation scheme,chemotherapy,and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex,age,immediate response,radiotherapy method,and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all.Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT,female patients,patients at a young age,patients with satisfactory immediate response,patients treated with full-course 3DCRT,and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients.A radiation dose of 60-66 Gy is recommended.