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[目的]探讨个体化胸部放疗在埃克替尼治疗有效的Ⅳ期NSCLC患者中的价值和可行性。[方法]回顾性分析2006年1月至2014年12月期间口服标准剂量埃克替尼有效的Ⅳ期NSCLC病例,同时接受原发灶放射治疗的患者43例。所有患者治疗中及治疗后评价毒副反应并进行复查和随访。[结果]随访截止日期为2016年10月16日,中位随访时间38.9个月,2例失访。到随访截止日期36例患者进展,中位肿瘤进展时间为15.0个月,1、2、3年无进展生存率分别为62.8%、39.5%和19.6%。32例患者死亡,全组中位生存时间为30.9个月,1、2、3年生存率分别为97.7%、71.8%和39.7%。所有患者均顺利完成放疗,两组常见毒副反应为皮疹、放射性食管炎和骨髓抑制,大多为1~2级。3级毒副反应发生率低,无4级及以上毒性。单因素分析发现基因突变类型(P=0.006)和是否肝转移(P=0.013)与预后相关,而女性(P=0.084)和生物放疗剂量≥62Gy(P=0.067)有提高生存的趋势。多因素分析提示基因突变类型(HR=1.565,95%CI:1.067~2.296)为影响预后的独立因素。[结论]具有EGFR活化突变Ⅳ期NSCLC患者采用单药埃克替尼联合局部放射治疗是可行的,有提高长期生存的潜力,且不良反应轻微,值得设计前瞻性随机对照研究进一步证实。
[Objective] To investigate the value and feasibility of individualized chest radiotherapy in patients with stage IV NSCLC treated with icotinib. [Methods] A retrospective analysis of 43 cases of patients with stage Ⅳ NSCLC who received standard dose of icitidine orally from January 2006 to December 2014 and who received radiation therapy of primary tumor at the same time. All patients were evaluated during treatment and after treatment side effects and review and follow-up. [Results] The deadline for follow-up was October 16, 2016, the median follow-up time was 38.9 months and two patients were lost to follow-up. Thirty-six patients were followed up until the end of follow-up. The median progression time was 15.0 months. The progression-free survival rates at 1, 2 and 3 years were 62.8%, 39.5% and 19.6%, respectively. 32 patients died, the median overall survival time was 30.9 months, 1, 2, 3-year survival rates were 97.7%, 71.8% and 39.7%. All patients were successfully completed radiotherapy, two common side effects of rash, radiation esophagitis and bone marrow suppression, mostly in 1 to 2. Grade 3 toxicity is low, no grade 4 and above toxicity. Univariate analysis showed that the type of mutations (P = 0.006) and liver metastases (P = 0.013) were associated with prognosis, whereas women (P = 0.084) and biochemotherapy doses ≥62Gy (P = 0.067) tended to increase survival. Multivariate analysis suggested that the type of gene mutation (HR = 1.565, 95% CI: 1.067-2.296) was an independent factor affecting the prognosis. [Conclusion] It is feasible to combine single-agent Icitinib with local radiotherapy in stage IV NSCLC patients with EGFR activating mutation. It has the potential to improve long-term survival with mild adverse reactions and is worthy of further prospective randomized controlled design.