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目的 探讨Ⅰ、Ⅱ期老年非小细胞肺癌 (NSCLC)放疗的价值。方法 对 1991年 1月至 1996年 12月首次治疗 ,年龄≥ 70岁 ,KPS≥ 60 ,Ⅰ、Ⅱ期NSCLC 73例患者进行分析。所有病例均经细胞学或组织学证实。患者中位年龄为 72岁 ( 70～ 81岁 )。治疗方案为根治性放疗和手术治疗 ,放疗组 46例 ,手术组 2 7例。统计用Kaplan Meier法及Log rank检验。 结果 放疗组与手术组 5年生存率分别为 5 2 %和 5 3 % (P >0 .0 5 ) ;5年胸腔局部肿瘤控制率分别为 3 0 %和 3 4 % (P >0 .0 5 ) ;5年远处转移率分别为 69%和 5 0 % (P >0 .0 5 )。治疗的并发症和毒副作用 ,放疗组 :并发急性放射性肺炎 5例 ( 11% ,5 /46) ,其中Ⅰ、Ⅱ级 3例 ,Ⅲ级 2例 ;急性放射性食管炎 2 2例 ( 4 8% ,2 2 /46) ,其中Ⅰ、Ⅱ级 2 0例 ,Ⅲ级 2例。手术组 :发生并发症 7例 ( 2 6% ,7/2 7) ,其中心律失常 3例 ,呼吸衰竭 2例 ,肺炎 1例 ,应激性消化道溃疡 1例 ;2组无 1例死于并发症。结论 Ⅰ、Ⅱ期老年NSCLC采用手术与放射治疗的疗效无显著性差异。对老年Ⅰ、Ⅱ期NSCLC ,放疗是手术以外的 1个可选择的重要治疗方法。
Objective To investigate the value of radiotherapy in stage I and II elderly non-small cell lung cancer (NSCLC). Methods From January 1991 to December 1996, the first treatment, age≥70 years, KPS ≥ 60, stage I, II NSCLC 73 patients were analyzed. All cases were confirmed by cytology or histology. The median age of the patients was 72 years old (70-81 years old). The treatment options included radical radiotherapy and surgery, 46 patients in the radiotherapy group, and 27 in the surgery group. Kaplan Meier method and Log rank test were used for statistics. Results The 5-year survival rates of radiotherapy and surgery groups were 5 2% and 5 3% respectively (P > 0.05). The 5-year local chest tumor control rates were 30% and 34%, respectively (P > 0. 5) The 5-year distant metastasis rates were 69% and 50% (P > 0.05). Treatment complications and toxic and side effects, radiotherapy group: 5 cases of acute radiation pneumonitis (11%, 5/46), of which I, II 3 cases, III 2 cases; acute radiation esophagitis in 22 cases (48% ,22/46), of which I, II class 20 cases, III class 2 cases. Surgical group: 7 cases of complications occurred (2 6%, 7/2 7), 3 cases of central arrhythmia, 2 cases of respiratory failure, 1 case of pneumonia, 1 case of gastrointestinal ulcer, and 1 case of 2 cases died of complication. Conclusion There is no significant difference in the efficacy of stage I and II elderly NSCLC with surgery and radiation therapy. For older stage I and II NSCLC, radiotherapy is an optional treatment alternative to surgery.