| objective:A retrospective analysis of curative effect of non-surgical stage Ⅲ/Ⅳ non-small cell lung cancer(NSCLC)with high biological effective dose(BED)hypofractionated radiotherapy,and analyse the difference of clinical factors and dosimetric parameters of radiation-induced lung injury.Compare the difference of overall survival,radiation-induced lung injury and dosimetric parameters whether adaptive radiotherapy.Methods:The data of 71 patients with stage Ⅲ/Ⅳ NSCLC who received high BED hypofractionated radiotherapy from January 2010 to December 2013 in Sichuan cancer hospital were collected and divided into adaptive radiotherapy group(A group)and non adaptive radiotherapy group(group B)according to the radiotherapy mode.For all,the median age was 60 years(36-91),52 males and19 females;clinical stage III 24 cases,stage IV 47 cases;radiotherapy physical dose was 61.8Gy(39-80),BED(alpha/beta=10)was 84Gy(75-127),BED(alpha/beta=3)was 129Gy(56.8-256),radiation time was 20 days(3-28).42 patients in group A received modified radiotherapy(ART group),the median age was 60 years(36-91);male 31 cases,female 11 cases;clinical stage III13 cases,stage IV 29 cases;radiotherapy physical dose was 65.5Gy(50.6-80Gy),BED(alpha/beta= 10)was 87.5Gy(76.5-127Gy),BED(alpha/beta=3)was130Gy(116-256),radiation time was 20 days(6-28).29 patients in group Breceived single radiotherapy(non ART group),the median age was 61 years(45-74);21 cases were male,8 female patients;clinical stage III 11 cases,stage IV 18 cases;radiotherapy physical dose of 60Gy(39-66.7Gy),BED(alpha/beta=10)was 78Gy(75-108.2),BED(alpha/beta=3)was 120Gy(56.8-220),radiation time was 20 days(3-26).The evaluation of the short-term curative effect adopts the solid tumor treatment,the curative effect evaluation RECIST standard,the side effect evaluation standard according to CTCAE V4.0.All the data were analyzed by SPSS 22 software.The bilateral P value was less than0.05 indicated that the difference was statistically significant.Results:Followed by the end of December 31,2016,the averge follow-up time was 63.4months(95%CI,56-70.8).The total response rate of the whole group was53.5%(38/71),the total response rate in group A was 59.6%(25/42),and the total response rate in group B was 44.8%(13/29),there was no significant difference between groups(c2=3.829,P=0.281).The median survival time in the whole group was 20.7 months(95%CI,16.6-24.8),23.6 months in the group A(95%CI,16.8-30.4),and 20.3 months in the group B(95%CI,13.7-26.9).The total OS 1,2,3 year was 83.1%,40.5% and 24.5%,respectively.In group A,1,2,3 year OS were 85.7%,48.4% and 22.9%,respectively.In group B,1,2,3 years OS were 78.9%,34.8% and 15.4%,respectively,and there was no significant difference between the groups(c2=1.545,P=0.214).There was no significant difference in the volume of GTV and volume of PTV between the two groups,and the P values were 0.657 and 0.985,respectively.In terms of DVH parameters of radiotherapy in the two groups.Two groups ofpatients suffering from ipsilateral lung D2 and ipsilateral lung D5 have significant differences,group A was significantly higher than the group B,the P values were 0.014 and 0.047.The whole group of more than grade 2 radioactive pneumonia incidence rate was 50.7%,group A,group B 51.7%,there was no significant difference between the two groups(c2=0.373,P=0.541).The whole group of more than grade 2 radiation pulmonary fibrosis was 33.8%,group A30.9%,group B 37.9%,there was no significant difference between groups(c2=0.373,P=0.541).Increased incidence of radiation-induced lung injury was found in patients with tumor diameter more than 5cm before treatment,more than grade 2 radiation pneumonitis and radiation pulmonary fibrosis(P=0.023,P < 0.001).Multivariate analysis showed that tumor diameter greater than 5cm before radiotherapy and radiotherapy time more than 20 days were independent risk factors of more than grade 2 radiation pneumonitis,P value was 0.027 and 0.045.Tumor diameter greater than 5cm before radiotherapy was independent risk factors of more than grade 2 radiation radiation-induced pulmonary fibrosis(P < 0.001).A separate analysis 36 cases more than grade 2radiation pneumonitis,there was significant differences in radiotherapy dose and tumor location whether ART patients,ART group(group A),radiotherapy dose over 60 Gy was 76.2%,non ART group(group B),radiotherapy dose over60 Gy was 13.3%,P < 0.001.A separate analysis of 24 cases of more than grade2 radiation-induced pulmonary fibrosis were found,there was significant differences in the physical dose radiotherapy,BED10,clinical stage and molecular targeted therapy,ART group(group A),The clinical subgroupanalysis,Patients with COPD,clinical stage III,no molecular targeted therapy and radiotherapy does less than 60 Gy underwent ART radiotherapy occurred more than grade 2 radiation-induced pulmonary fibrosis was significantly lower than non ART radiotherapy,P values were 0.024,0.005,0.014 and 0.026.Conclusion:1.Non operative stage Ⅲ/Ⅳ non-small cell lung cancer patients with high BED hypofractionated radiotherapy is safe and feasible,adaptive radiotherapy is helpful to improve the dose of radiotherapy without increasing the incidence of radiation-induced lung injury;the incidence of 2.Tumor diameter before treatment is independent risk factors of over grade 2radiation-induced lung injury.3.COPD,clinical stage III,without targeted therapy or radiotherapy dose less than 60 Gy patients with ART radiotherapy can reduce over grade 2 radiation-induced pulmonary fibrosis. |
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