| Objective:In recent years, the morbidity and mortality of lung cancer is a malignanttumor, however non-small cell lung cancer accounts for most. Because of theearly symptoms isn’t obvious, most patients are in locally advanced whenfound, lost opportunity to operation are. How to improve the locally advancednon-small-cell lung cancer (LA-NSCLC) patients’ survival and quality of lifehas always been the hot spot of the medical community to explore. In recentyears, concurrent chemo-radiotherapy as a standard treatment for LA-NSCLCis widely used, but due to the increase in adverse reaction, make the most ofpatients can’t tolerate;Radioactive pneumonia affect the quality of life ofpatients seriously, which happens at1-3months after the end of theradiotherapy, and cannot evaluate at the radiation process, therefore, manypatients give up chemo-radiation therapy, and chose the sequential radiationand chemotherapy or radiotherapy alone. The latest2013NCCN guidelinesdeleted the view of chemo-radiation better than sequential radiation andchemotherapy or radiotherapy alone at LA-NSCLC, but didn’t point out whatkind of method for the standard treatment of LA-NSCLC.Methods:To retrospectively analyze the clinical characteristics of our hospitalconfirmed91case LA-NSCLC patients between January2008and December2008.The91LA-NSCLC patients were divided into chemo-radiation therapygroup (27cases), sequential chemo-radiotherapy group (41cases), simpleradiotherapy group (23cases);10cases of radiation pneumonia.Follow-up ofpatients survival circumstances and the occurrence of neumonia, and analyzesthe impact of nutrition status at survival. Apply SPSS17.0Kaplan Meiermethod to calculate survival rate, and the Log-rank test was carried out on the single factor univariate analysis, compare the survival, Cox proportionalhazards regression model analyze multiple factors for the significative singlefactor;Chi-square test analyze the single factors’ relations with radioactivepneumonia, Logistic multivariate regression analyze multi-factor form thestatistical significance single factors, all of the data as P <0.05for havestatistically significant.Results:1.91LA-NSCLC patients’ medical records: the110cases of LA-NSCLCpatients were followed up,19cases were lost to follow-up,5cases to thedeadline for survival. To analyze the91cases of LA-NSCLC patients whichhave follow-up results.Concurrent chemo-radiotherapy group of27cases, thesequential chemo-radiotherapy group41cases and23cases of simpleradiotherapy group; Gender: male71cases,20cases; Age:35-74years, themedian age:57years old; Pathological types:48cases squamous carcinoma,adenocarcinoma of43cases; Clinical stage: Ⅲ A period48cases, ⅢB43patients;10cases of pneumonia after radiotherapy;white blood cells is lowerthan4x109/L62cases; Hemoglobin is less than100g/L39cases; Platelet islower than100x109/L17cases; Creatinine is lower than44umol/L39cases; Albumin is below35g/L31cases; Body mass index [weight(kg)/height2(m2)]32cases was less than20. Chemo-radiation, sequentialrehabilitation group and the simple radiotherapy group of gender, age, KPSscore, clinical stage, pathological type, hemoglobin, body mass index, therewas no significant difference (P>0.05).The median survival and the survival rate of91patients: the mediansurvival time of chemo-radiation group, Sequential chemo-radiation group andPure radiation therapy group are25.40months,20.34months and20.34months, chi-square=14.050, P <0.001, the difference has statisticallysignificant. The1year survival rate of chemo-radiation group, Sequentialchemo-radiation group and Pure radiation therapy group are81%,80%,66.7%,2year survival rates are55.6%,25%,8.3%,3year survival rate are25.9%,12.5%and4.1%. 91case patients survival factor analysis: To analyze the single factors ofgender, age, pathological type, clinical stage, radioactive pneumonia,treatment, white blood cells, hemoglobin, platelet, creatinine, albumin, bodymass index, to multi-factor analyze the meaningful five single factors of age,treatment, hemoglobin, albumin, body mass index. Select chemo-radiation asbetter prognosis factor of LA-NSCLC patients, and hemoglobin and weightloss as poor prognosis factors of LA-NSCLC patients.4.The occurrence of radioactive pneumonia in91cases of LA-NSCLCpatients: The incidence of radioactive pneumonia in chemo-radiation group,Sequential chemo-radiation group and Pure radiation therapy group are18.52%,7.50%,8.33%, chi-square=2.236, P>0.05). Chemo-radiationincreases the incidence of radioactive pneumonia as sequentialchemo-radiation and pure radiation, but there was no statistically significantdifference.5. Influence factors analysis of radioactive pneumonia in91LA-NSCLCpatients: a retrospective study of91cases of LA-NSCLC patients, including10cases of radiation pneumonia, single factor analysis show that double lungV550%or higher, V1043%or higher, V2030%or higher, V3025%orhigher, V5015%or higher, with lung V580%or higher, V1070%or higher,V2060%or higher, V3050%or higher, V5030%or higher influence theoccurrence of radioactive pneumonia at three-dimensional conformalradiotherapy for LA-NSCLC.Apply Logistic multivariate regression analysisto analyze the meaningful single factors, made on the double lung V10, V20,V30, and with lung V10for radioactive pneumonia happened independentfactors.Conclusion:1.Chemo-radiation improve the median survival time and survival rateof LA-NSCLC patients as sequential chemo-radiation and pure radiation.Chemo-radiation is better prognosis factor of LA-NSCLC patients, andhemoglobin and weight loss are poor prognosis factors of LA-NSCLCpatients. 2.Chemo-radiation increases the incidence of radioactive pneumonia assequential chemo-radiation and pure radiation, but there was no statisticallysignificant difference. Double lung V1043%or higher, V20acuity30%,25%and lung V10V30acuity70%or greater independent risk factors forradioactive pneumonia happened.double lung V10, V20, V30, and with lungV10are independent factors for radioactive pneumonia happened. |
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