| ObjectivePatients with newly diagnosed stage IV non-small cell lung cancer(NSCLC)who were effectively controlled by 6 cycles chemotherapy were treated with chest involved field radiotherapy.By comparing the short-term efficacy,survival and toxicity,evaluate the efficacy and tolerability of chest involved field radiotherapy with chemotherapy in the treatment of stage IV NSCLC.MethodWe collected 82 cases of newly diagnosed stage IV NSCLC who were effectively controlled by 6 cycles chemotherapy form August 2011 to January 2014.All cases were confirmed by cytology or histology that were divided into treatment group and control group,42 cases in each group.Control group was given symptomatic and supportive treatment.Treatment group not only was given symptomatic and supportive treatment,but also was treated with Chest involvement 3D-CRT radiotherapy.All cases were followed up to February 2017,and all of the 84 patients were dead,the longest follow-up time was 56 months.Observe two groups cases with progression free survival(PFS),efficacy,survival time(OS),the one year survival rate,the tow year survival rate,Chest symptom rate.Result42 patients in the treatment group were evaluated by chest CT scan after 1 months of radiotherapy:3 cases of thoracic primary tumor CR(7.14%),28 cases of PR(66.67%),9 cases of SD(21.43%),2 cases of PD(4.76%),the effective rate was 31/42(73.81%),no efficiency was 11/42(26.19%).31 patients with CR or PR after radiotherapy for primary breast tumor,there were 22 patients with the largest diameter<3cm before primary radiotherapy,9 patients with the largest diameter?3cm.The median PFS of the treatment group and the control group were 7.1 months and 4.5 months,respectively,The difference between the two groups was statistically significant(?2= 27.045,P=0.000).The PFS rate of the treatment group was higher than that of the control group at 3 months,6 months and 9 months.The median OS of the treatment group and the control group were 22.3 months and 13.5 months,the difference between the two groups was statistically significant(?2=5.908,P=0.015).The OS rate of the treatment group was higher than that of the control group at 1 and 2 years The treatment group compared with the control group,after three months,The incidence of chest pain in the treatment group was 16.67%(7/42),and the incidence of chest pain in the control group was(15/42).The incidence of chest pain in the treatment group was lower than that in the control group,the difference was statistically significant(?2=3.941,P=0.047).The incidence of hemoptysis or sputum in the treatment group was 7.14%(3/42),and the incidence of hemoptysis or sputum in the control group was 26.19%(11/42).The incidence of hemoptysis or sputum in the treatment group was lower than that in the control group,the difference was statistically significant(?2 =5.4863,P=0.019).The incidence of chest wall invasion was 4.76%(2/42)in the treatment group,and the incidence of chest wall invasion in the control group was 7.14%(3/42).The incidence of chest wall invasion in the treatment group was lower than that in the control group,but their difference was no statistical significance(?2 =0.000,P=1.000).There were 29 cases of radiation esophagitis in the treatment group,which there were 25 cases in the first degree,4 cases in the second degree,0 cases in the third and fourth degree.All the cases of radiation dermatitis were from the first to the second degree,and there were no cases of the third degree or above.Review the chest CT in the radiotherapy 25 times and 1 months after radiotherapy.The results showed that there were 31 cases of radiation pneumonia,including 25 of grade ?,2 of grade ?,1 of grade?,and no grade IV cases.Among them,2 cases had symptomatic radiation pneumonitis,and the 2 cases were discharged after improvement.Hematological toxicity was mainly reduced by white blood cells or neutrophils,and most of them were from from the first to the second degree,only 8 cases were third degree.No significant cardiac toxicity occurred.No death related to radiotherapy.Conclusion1.Chest field radiotherapy can improve PFS and OS of stage IV NSCLC patients who treated with 6 cycle standard chemotherapy and reduce the incidence of chest pain,hemoptysis and sputum.2.The better the local control of the primary breast tumor,the easier to get better PFS and OS.3.Chemotherapy followed by chest involved field radiotherapy in the treatment of stage IV non-small cell lung cancer was safe and effective. |
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