| Background and Objective As the malignant tumor with highest morbidity and mortality in China,lung cancer in pathology mainly can be divided into non-small cell lung cancer(NSCLC)and small cell ling cancer,among which 85% cases are non-small cell lung cancer.Single or multiple organ with one or more metastases are found in about 50% of patients with non-small cell lung cancer are during the first diagnosis.Usually,the prognosis of IV stage non-small cell lung cancer is poor.However,some scholars proposed the concept of “oligometastasis” in recent years.Oligometastasis refers to the period that tumor biological invasion is mild,which is the transition stage between local primary lesion and extensive metastasis;so there is potential healing possibility if render positive comprehensive treatment at this stage.The lung cancer oligometastasis is defined as ?5 metastatic tumors after comprehensive imageological diagnosis,regardless of metastasis part or number of metastatic organs.This research preliminarily explores the curative effect and feasibility SBRT and definitive radiation therapy in treating non-small cell lung cancer oligometastasis.Materials and Methods43 patients with non-small cell lung cancer oligometastasis hospitalized in our hospital during February 2009-February 2015 were analyzed with applying SBRT or radical radiation therapy to both primary lesions and metastases.In initial diagnosis,41 cases received PET-CT and 2 cases did not;33 cases carried signal organ metastasis and10 cases carried multiple organs metastasis;19 cases carried single metastasis,14 cases carried 2 metastases and 10 cases carried 3-5 metastases with treating 226 lesions(including regional metastasis lymph nodes);the average and neutral position BED10 respectively were 101.416 Gy and 102.700Gy;the number of neutral position chemotherapy cycle was 4.Kplan-Meier was adopted to draw survival curve chart;cox regression analysis was used for single factor analysis;implemented cox regression analysis on factors with single factor analysis P<0.05 for multi-factor survival analysis.All tests in this paper were two-sided tests with taking results of P<0.05 as statistically significant difference.Results:By the end of January 10,2017 in 36 months' neutral position follow-up visit,1patient lost the visit with 97.6% of follow-up rate.For short-term effect,13 cases were in completed remission(30%),24 cases obtained partial remission(56%),5 cases were stable,and 1 case was in progress(2%);so the total effective rate of therapy was 86%.The survival rates after 1,2 and 3 years respectively were 74.42%,69.54% and 51.00%;neutral survival time was 48 months,95% credibility interval was 37.428-58.572months;the progression-free survival rates after 1,2 and 3 years respectively were30.23%,18.60% and 15.50%.The progression-free time of neutral position was 15 months,95% credibility interval was 9.860-20.140 months.24 patients among the 43 cases died,where 17 cases died of multiple organ failure caused by tumor progression,1died of pulmonary embolism,1 died of severe lung infection and 5 cases died of unknown reasons.Multi-factor analysis indicated that,ECOG<2 and ECOG?2(HR,6.545;95%CI,2.472-17.334;p=0.000),BED10 < 100 Gy and BED10 ? 100Gy(HR,0.272;95%CI,0.109-0.683;p=0.006)generated obvious influence on survival prognosis.Other factors,such as age,gender,smoking history,smoking index,pathological pattern,N staging,metastasis in important organ,number of metastatic organs and number of metastasis,were not obviously significant on survival prognosis.Only slight adverse reaction appeared in most patients without therapy related death. |
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