非小细胞肺癌放射治疗进展王绿化.ppt

非小非小细胞肺癌放射治胞肺癌放射治疗进展王展王绿化化影像技术和计算机技术的进步为精确放射治疗的实现影像技术和计算机技术的进步为精确放射治疗的实现提供可能提供可能2020/12/1822020/12/1832020/12/184屏气技术举例屏气技术举例:Elekta ABCElekta ABC2020/12/185四维四维CTCT影像技术影像技术呼气吸气螺旋开始时相时相由吸转呼呼气末由呼转吸由吸转呼呼气吸气螺旋开始呼吸曲线呼吸曲线床位床位2020/12/186影像引导放射治疗技术影像引导放射治疗技术影像引导放射治疗技术影像引导放射治疗技术IGRTIGRT 40对叶片MLCKV级X射线球管KV级探测器阵列MV级探测器阵列2020/12/187在线校正在线校正在线校正在线校正影像匹配影像匹配影像匹配影像匹配2020/12/188一、放射治疗在肺癌治疗中的地位一、放射治疗在肺癌治疗中的地位二、早期二、早期NSCL的放射治疗的放射治疗三、局部晚期三、局部晚期NSCL的放疗的放疗/化疗化疗 综合治疗综合治疗 四、四、3DCRT提高提高NSCLC的生存率的生存率五、术后放射治疗五、术后放射治疗2020/12/189一、放射治疗在肺癌治疗中的地位一、放射治疗在肺癌治疗中的地位一、放射治疗在肺癌治疗中的地位一、放射治疗在肺癌治疗中的地位l应用循证医学的方法评价放射治疗在肺癌治疗中的地位。2020/12/18102020/12/1811RT RT 在在在在 SCLCSCLC治疗中的地位治疗中的地位治疗中的地位治疗中的地位l53.6%3.3%SCLC 病例在其疾病的不同时期需要接受放射治疗 45.4%4.3%为首程治疗 （in the initial treatment）.8.2%1.5%为复发和进展病例的治疗（later for recurrence or progression）2020/12/1812 RT RT 在在在在 NSCLC NSCLC 治疗中的地位治疗中的地位治疗中的地位治疗中的地位l64.3%4.7%of NSCLC cases require RT.45.9%4.3%in their initial treatment.18.3%1.8%later in the couse of the illness2020/12/1813二、早期非小细胞肺癌的放射治疗二、早期非小细胞肺癌的放射治疗二、早期非小细胞肺癌的放射治疗二、早期非小细胞肺癌的放射治疗 放射治疗能够使 早期NSCLC获得治愈 2020/12/1814Japanese StudiesJapanese StudiesI I期期期期NSCLCNSCLC大剂量分割大剂量分割大剂量分割大剂量分割SRTSRT获得满意的局部控制率获得满意的局部控制率获得满意的局部控制率获得满意的局部控制率Institute Dose/fx/OTT LC/Follow-upUematsu 50-60/5-10/5d 94%(47/50)36MKyoto 48Gy/4fr/12d 96%(49/51)20M Arimoto 60Gy/8fr/11d 92%(22/24)24MOnimaru 60Gy/8fr/11d:88%(50/57)18M Nagata Y,Kyoto Univ,IASLC,20042020/12/1815Summary of Japanese StudiesSummary of Japanese StudieslTotal cases：281lAge:39-92(median 76)yearslPulmonary disease:Positive:172,Negative:109lHistology:Sqamous:122Adeno:131,Others:28lStage:IA:178,IB:103lTumor diameter:7-58(median 23)mmlMedical Operability:Inoperable:177,Operable:104Onishi H,ASCO 20042020/12/1816Local Control and ComplicationLocal Control and ComplicationlFollow-up period 2-128(median 30)monthslLocal responseCR 26.9%PR 59.1%NC 14.0%lPneumonitis(NCI-CTC)Grade 0:33.7%Grade 1:59.9%Grade 2:4.0%Grade 3:1.2%Grage 4:1.2%lEsophagitis(Grade 3)1.2%lPleural effusion(transient)1.6%lRib fracture1.2%lBone marrow suppression0.0%Onishi H,ASCO 20042020/12/1817Local Failure RatesLocal Failure RateslTotal cases38/281(13.5%)BED 100 Gy17/211(8.1%)lStage IA17/177(9.6%)BED 100 Gy 9/136(6.6%)lStage IB21/102(20.6%)BED 100 Gy 8/73(11.0%)lAdenocarcinoma17/122(14.0%)lSquamous cell ca.18/131(13.7%)Onishi H,ASCO 20042020/12/1818Mountain*JCOG*JNCCH*Stage IAStage IB67%57%80%63%74%53%STI*90%84%*Surgery*Stereotactic IrradiationComparison of 5-Yr Overall Survival Between Surgery&STISurvival curves of operable pts irradiated with BED of 100 Gy or more according to Stagestage IA(n=47)stage IB(n=16)p=0.2Overall SurvivalOverall SurvivalTime(years)Time(years)Summary of Japanese StudiesOnishi H,ASCO 20042020/12/1819I I期非小细胞肺癌立体定向放射治疗或楔形切除后的转归期非小细胞肺癌立体定向放射治疗或楔形切除后的转归SRBT(n=55)楔形切除楔形切除(n=69)P肺功能（肺功能（FEV-1）1.39(0.86-2.37)1.31(0.52-3.0)NSCharlson合并症指数合并症指数 3(1-4)4(3-6)0.01年龄年龄74(69-78)78(55-89)RT(60 Gy,2Gy QD)day 50 同步同步:PV/RT(60 Gy,2Gy QD)day 1 同步同步/HFRT:PE/HFRT(69.2 Gy,1.2Gy BID)day 1PV:顺铂顺铂/长春花碱长春花碱PE:顺铂顺铂/oral 足叶乙甙足叶乙甙RT:放疗放疗;QD:每日一次每日一次;HFRT:超分隔放疗超分隔放疗Curran:ASCO,2000;updated IASLC 2000;ASTRO 2001,2003RANDOMIZE2020/12/1834二二.同时化放疗同时化放疗 vs 序贯化放疗序贯化放疗(2)SEQ CON-QD CON-BID 中位生存期：中位生存期：14.6 17 15.6（月）（月）4 年生存率：年生存率：12%21%17%p=0.046 G3急性和晚期非血液系统毒性：急性和晚期非血液系统毒性：30%，48%，62%和和 14%，15%，16%。Curran W et al.Pro.Am Soc Clin Oncol.J.Clin.Oncol.2003;(abstract 2499)2020/12/18352020/12/18362020/12/1837结论：结论：结论：结论：同步放化疗优于序贯放化疗，但是，急性毒性反应增加同步放化疗优于序贯放化疗，但是，急性毒性反应增加同步放化疗优于序贯放化疗，但是，急性毒性反应增加同步放化疗优于序贯放化疗，但是，急性毒性反应增加2020/12/1838同步放化疗同步放化疗同步放化疗同步放化疗？诱导化疗？诱导化疗?巩固化疗巩固化疗2020/12/1839同步放化疗同步放化疗同步放化疗同步放化疗诱导化疗诱导化疗2020/12/1840Induction Chemotherapy Followed by Chemoradiotherapy With Chemoradio-therapy Alone for Regionally Induction Chemotherapy Followed by Chemoradiotherapy With Chemoradio-therapy Alone for Regionally Advanced Advanced Unresectable StageIII NonSmall-CellUnresectable StageIII NonSmall-CellLung:Cancer and Leukemia GroupBLung:Cancer and Leukemia GroupBCALGB 39801CALGB 39801J Clin Oncol.2007 May 1;25(13):1698-704.Epub 2007Apr 2020/12/1841CALGB 39801 study designCALGB 39801 study designlJuly 1998 and was closed in May 2002,Totally 366 patients registered2020/12/1842Survival intent to treatSurvival intent to treat2020/12/1843Survival of eligible patients with a Survival of eligible patients with a weight loss of 5%weight loss of 5%2020/12/1844DiscussionDiscussion 增加毒性增加毒性 induction chemotherapy increases neutropenia and overall maximal toxicity 没有生存优势没有生存优势 No survival benefit over concurrent therapy alone同期放化疗是标准的治疗模式同期放化疗是标准的治疗模式 Concomitant chemoradiotherapy is current standard therapy for unresectable stage IIIB NSCLC2020/12/1845Simultaneous Chemoradiotherapy Compared With Radiotherapy Alone After Induction Simultaneous Chemoradiotherapy Compared With Radiotherapy Alone After Induction Chemotherapy in Inoperable Stage IIIA or IIIB NonSmall-Cell Lung Cancer:Chemotherapy in Inoperable Stage IIIA or IIIB NonSmall-Cell Lung Cancer:Study CTRT99/97 by the Bronchial Carcinoma Therapy GroupRudolf M.Huber,Michael Flentje,Michael Schmidt,Barbara Pllinger,Helga Gosse,Jochen Willner,Rudolf M.Huber,Michael Flentje,Michael Schmidt,Barbara Pllinger,Helga Gosse,Jochen Willner,and Kurt Ulmand Kurt UlmPC x 3诱导化疗诱导化疗RandomizeRT aloneRT+Paclitaxel 60mg/m2 weekly2020/12/1846paclitaxel 200 mg/m2 carboplatin AUC=6every 3 weeks X 2 cyclespaclitaxel 60 mg/m2 weeklyRadiotherapy alone2020/12/18472020/12/1848Survival after induction chemotherapy for patients with complete or partial responseSurvival after induction chemotherapy for patients with complete or partial response2020/12/1849同步放化疗同步放化疗同步放化疗同步放化疗巩固化疗巩固化疗2020/12/1850SWOG 9504SWOG 9504:同步放化疗后应用泰索帝同步放化疗后应用泰索帝同步放化疗后应用泰索帝同步放化疗后应用泰索帝 巩固化疗治疗巩固化疗治疗巩固化疗治疗巩固化疗治疗IIIb IIIb 期期期期NSCLCNSCLC顺铂顺铂/VP-16 X XRT泰索帝泰索帝 X X X 顺铂顺铂 50mg/m2 d 1,8,29,36 VP-16 50mg/m2 d1-5,29-33RT:61 Gy:45Gy(1.8Gy/fx),16Gy 缩野缩野(2Gy/fx)泰索帝泰索帝:75mg/m2 cycle 1 -100mg/m2 cycle 2-3 2020/12/1851SWOG 9504:SWOG 9504:总生存总生存总生存总生存%0 02 2 0 04 4 0 06 6 0 08 8 0 01 1 0 0 0 0%0 01 12 22 2 4 43 3 6 64 48 8入组时间（月）入组时间（月）入组时间（月）入组时间（月）N EventsN Events中位生存中位生存中位生存中位生存83834545 26 26月月月月2 2 年生存率年生存率年生存率年生存率:54%:54%3 3 年生存率年生存率年生存率年生存率:37%:37%2020/12/1852 SWOG 9504 SWOG 9504 和和和和 SWOG 9019SWOG 9019比较比较比较比较研究研究病例病例MST(月)2 年生存年生存3 年生存年生存S9019(PE/RT PE)5015(10-22)*34%(21-47)*17%(7-27)*S9504(PE/RT 泰索帝泰索帝)8326(18-35)*54%(43-65)*37%(22-52)*95%CI2020/12/1853SWAG 0023SWAG 0023Concurrent Chemo/RadioDDP+Vp16/RTConsolidation ChemoDocetaxel MaintenanceGEFITINIB orPLACEBO2020/12/18542020/12/1855同步放化疗同步放化疗同步放化疗同步放化疗巩固化疗巩固化疗Results of ASCO 20072020/12/1856HOG LUN 01-24 Phase III Study DesignHanna et al.ASCO 2007:Abstract 7512.ChemoRTCisplatin 50 mg/m2 IV d 1,8,29,36Etoposide 50 mg/m2 IV d 1-5&29-33Concurrent RT 59.4 Gy(1.8 Gy/fr)Stratificationat randomization PS 0-1 vs 2 IIIA vs IIIB CR vs non-CR Inclusion at baseline Unresectable stage IIIA or IIIBNSCLC ECOG PS 0-1 at study entry(+PS2 at random)FEV-1 1 liter at study entry203 patients147 patients73 patients74 patientsTaxotere75 mg/m2 q 3 wk 3ObservationPrimary endpoint:OSSecondary endpoints:PFS,toxicity2020/12/1857HOG LUN 01-24:OS(ITT)Randomized Patients(n=147)Hanna et al.ASCO 2007:Abstract 7512.Months Since Registration0102030405060Percent of patients surviving0%25%50%75%100%P-value:0.940Median3 yearsurvival rateObservation18.0-34.227.6%Taxotere17-34.827.2%2020/12/1858Comparison of Grade 3-5 ToxicitiesToxicitySWOG 9504SWOG 0023HOG 01-24Febrile Neutropenia PE/XRT Docetaxel NR 9%5%*5%*9.9%10.9%Esophagitis17%14%17.2%Pneumonitis 7%7%8.2%Docetaxel-related death4.8%4%5.5%*reported as“infection with neutropenia”2020/12/1859Hog LUGN o1-20/USO-023Hog LUGN o1-20/USO-023 The MST with EP/XRT was higher than historical controls;Consolidation D does not further improve survival,is associated with significant toxicity including an increased rate of hospitalization and premature death,And should no longer be used for pts with unresectable stage III NSCLCConclusions2020/12/1860术前同时化放疗的临床研究术前同时化放疗的临床研究2020/12/1861可手术（可手术（可手术（可手术（OperableOperable）A(N2)A(N2)放放放放/化疗化疗化疗化疗 vs vs 放化疗放化疗放化疗放化疗+手术手术手术手术 RTOG 93-09 INTRTOG 93-09 INT：0139 0139 2020/12/1862CT/RT/S 145/202CT/RT 155/194Logrank p=0.24危险比危险比=0.87(0.70,1.10)存活率存活率%0255075100从随机分组开始后的月数从随机分组开始后的月数01224364860死亡死亡/总数总数INT0139INT0139试验试验试验试验:总生存总生存总生存总生存中位中位FU 81 个月个月Albain et al.ASCO 2005.Abstract 7014.2020/12/1863随机分组后的月数随机分组后的月数 MS3 yr OS5 yr OS19月月 36%22%CT/RT/SCT/RT存活率存活率%025507510001224364860/29月月 45%24%死亡死亡/总计总计CT/RT/S38/51CT/RT42/51Log rank p=NSINT0139INT0139试验试验试验试验:肺切除亚组和相应化疗肺切除亚组和相应化疗肺切除亚组和相应化疗肺切除亚组和相应化疗/放疗亚组的总生存的比较放疗亚组的总生存的比较放疗亚组的总生存的比较放疗亚组的总生存的比较Albain et al.ASCO 2005.Abstract 7014.2020/12/1864Logrank p=0.002CT/RT/S 57/90CT/RT 74/90死亡死亡/总计总计存活率存活率%0255075100随机分组后的月数随机分组后的月数01224364860/MS 34月月 22 月月5 yr OS 36%18%CT/RT/SCT/RTINT0139INT0139试验试验试验试验:肺叶切除亚组和相应化疗肺叶切除亚组和相应化疗肺叶切除亚组和相应化疗肺叶切除亚组和相应化疗/放疗亚组的总生存的比较放疗亚组的总生存的比较放疗亚组的总生存的比较放疗亚组的总生存的比较Albain et al.ASCO 2005.Abstract 7014.2020/12/18652020/12/1866 EORTC 08941 A：Unresectable pN2不能手术的不能手术的ApN2病例病例通过诱导化疗后成为可手术病例通过诱导化疗后成为可手术病例是选择手术还是选择放疗？是选择手术还是选择放疗？2020/12/18672020/12/18682020/12/18692020/12/18702020/12/1871四、四、四、四、NSCLCNSCLC术后放射治疗术后放射治疗术后放射治疗术后放射治疗New data supports PORT in N2 cases2020/12/18721998 PORT1998 PORTl死亡风险增加 21%l2年OS 下降7 55%-48%lpN0 pN1 有害lpN2 降低局部复发 对OS无明确结论PORT Meta-analysis Lancet,1998.352:257-63Update of PORT Lung Cancer,2005.47:81-32020/12/1873New Data 1New Data 1回顾分析回顾分析回顾分析回顾分析PORTPORTSEER 1988年年2001年年、期期NSCLC 7465例例根治性术后根治性术后PORT 3508例（例（47%）SEER J Clin Oncol,2006.24:2998-3006 预后多因素分析预后多因素分析HR95%CI Polder age1.0251.022-1.0280.0001T3-4 disease1.2881.117-1.4840.0005N2 nodal disease1.2811.101-1.4900.0014greater number of involved lymph nodes1.0431.027-1.0600.0001PORT1.0480.987-1.1130.12692020/12/1874PORTPORT在在N2N2中的作用中的作用N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%38%27%36%P0.04350.01960.0077PORT既能够提高既能够提高OS也能够提高也能够提高DSSN0N1N22020/12/1875New Data 2Results from ANITA:Phase III Adjuvant Vinorelbine and Cisplatin versus Observation in Completely Resected Non-Small-Cell Lung Cancer PatientsR Rosell,M De Lena,F Carpagnano,R Ramlau,JL Gonzalez-Larriba,T Grodzki,A Le Groumelec,D Aubert,J Gasmi,JY Douillard on behalf of the A Adjuvant N Navelbine I International T Trial A Association2020/12/1876CT RTCTRTOBSPORT in N1 PatientsPORT in N1 PatientsRT is better than OBS.For patient who can not tolerate CT,RT would be recommended.2020/12/1877CT RTCTRTOBSPORT in N2 PatientsPORT in N2 Patients0.000.250.500.751.00DURATION OF SURVIVAL(MONTHS)020406080100120CT&RT is the bestRT is better than OBS 2020/12/1878New Data 3 from New Data 3 from Cancer Hospital&Institute of CAMSCancer Hospital&Institute of CAMS根治性切除根治性切除NSCLCT1-3,N2具备完整治疗信息具备完整治疗信息 一般临床资料一般临床资料 术中所见及术后病理术中所见及术后病理 治疗模式及参数治疗模式及参数 随访资料随访资料2020/12/1879材料与方法材料与方法排除标准排除标准T4N2者者pN3病例及病例及N分期不明者分期不明者手术后手术后3个月内死亡的患者个月内死亡的患者手术后手术后3个月内肿瘤进展者个月内肿瘤进展者单纯探查术或纵隔镜活检术单纯探查术或纵隔镜活检术2020/12/1880材料与方法材料与方法全组全组例数例数PORT无无PORT术式术式肺叶切除肺叶切除19784113全肺切除全肺切除241212清扫淋巴结数目清扫淋巴结数目总数（枚）总数（枚）1-603-601-60中位数（枚）中位数（枚）2119222020/12/1881OS例数例数MST(月月)1年年3年年5年年2P值值无无PORT 12531.977.645.430.65.2350.046PORT 9643.994.859.134.3生存率生存率 2020/12/1882DFS 1年年3年年5年年2P值值无无PORT 56.428.216.56.8910.009PORT 76.139.832.1DFSDFS2020/12/1883治疗模式与生存率治疗模式与生存率治疗模式与生存率治疗模式与生存率 项目项目例数例数MST(月月)1年年OS3年年OS5年年OSS+C+R6148.396.7%63.9%38.2%S+R3538.391.4%51.0%33.7%S+C10033.182.0%46.7%31.9%S2521.661.5%38.5%23.1%2020/12/1884非肿瘤死亡非肿瘤死亡非肿瘤死亡非肿瘤死亡项目项目 例数例数无术后放疗无术后放疗术后放疗组术后放疗组 心功能衰竭心功能衰竭10心肌梗死心肌梗死10小脑萎缩小脑萎缩10急性胰腺炎急性胰腺炎10脓胸脓胸10脑血管意外脑血管意外11肺部感染肺部感染21气管食管瘘气管食管瘘01肺栓塞肺栓塞01不明原因消瘦不明原因消瘦01死亡原因不明死亡原因不明22合计合计107u有无术后放疗组的非肿瘤死亡率并无差异（有无术后放疗组的非肿瘤死亡率并无差异（p=0.493）2020/12/1885S+C+R S+CS+RS5yOS47.0%34.0%21.3%16.6%5yOS38.2%31.9%33.7%23.1%MST（M）47.423.822.712.7MST（M）48.333.138.321.6ANITA的结果的结果医科院肿瘤医院的结果医科院肿瘤医院的结果完全切除的完全切除的AN2 NCSLC推荐术后化疗推荐术后化疗+放疗放疗2020/12/1886Absolute Volume of lung received 30GyRP(%)NO RP(%)P 340 cm329.2(7/24)70.8(17/24)0.003340 cm32.5(1/40)97.5(39/40)PORT can be safely used with 3DCRT PORT can be safely used with 3DCRTGraph 1.&Table 4.ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.757(P=0.020).Graph 1.&Table 4.ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.757(P=0.020).Graph 1.&Table 4.ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.757(P=0.020).Graph 1.&Table 4.ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.757(P=0.020).Ji Wei et al:ASTRO meeting 2008 BostonConclusion：It was safe for patients with NSCLC to receive postoperative 3DCRT，if irradiation dose to lung tissue was well defined.2020/12/18873DCRT3DCRT能够提高能够提高能够提高能够提高NSCLCNSCLC的治疗疗效的治疗疗效的治疗疗效的治疗疗效 2020/12/1888Int.J.Radiation Oncology Biol.Phys.,Vol.66,No.1,pp.108116,2006Int.J.Radiation Oncology Biol.Phys.,Vol.66,No.1,pp.108116,20063D vs 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a)Overall survival(b)Disease-specific survival2020/12/1889Int.J.Radiation Oncology Biol.Phys.,Vol.66,No.1,pp.108116,2006Int.J.Radiation Oncology Biol.Phys.,Vol.66,No.1,pp.108116,20063D vs 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional control2020/12/18903 DCRT vs 3 DCRT vs 常规放疗常规放疗常规放疗常规放疗 中国医学科学院肿瘤医院中国医学科学院肿瘤医院中国医学科学院肿瘤医院中国医学科学院肿瘤医院 2001-20062001-20062020/12/1891期期期期NSCLCNSCLC适形放疗适形放疗适形放疗适形放疗 vs vs 常规放疗常规放疗常规放疗常规放疗2020/12/1892局部晚期局部晚期局部晚期局部晚期NSCLCNSCLCNSCLCNSCLC（A/BA/B）3DCRT vs 3DCRT vs 3DCRT vs 3DCRT vs 常规放疗常规放疗常规放疗常规放疗分组分组例数例数1 1年年3 3年年5 5年年MSTMST常规放疗常规放疗27561.061.013.813.88.08.015.615.63-DCRT3-DCRT21873.373.326.126.114.414.420.120.15 5年年OS 6.4%OS 6.4%MST 4.5MST 4.5月月2020/12/1893局部晚期局部晚期局部晚期局部晚期NSCLCNSCLCNSCLCNSCLC（A/BA/B）3DCRT vs 3DCRT vs 3DCRT vs 3DCRT vs 常规放疗常规放疗常规放疗常规放疗分组分组例数例数1 1年年3 3年年5 5年年常规放疗常规放疗27565.165.116.716.711.211.23-DCRT3-DCRT21879.079.033.333.320.820.82020/12/1894OSOSOSOS单因素及多因素单因素及多因素单因素及多因素单因素及多因素COXCOXCOXCOX分析分析分析分析变量变量单因素单因素多因素多因素危险比危险比P P 值值危险比危险比P P 值值70 vs 7070 vs 70岁岁1.0351.0350.7440.744-女性女性 vs vs 男性男性1.0751.0750.5520.552-体重下降体重下降(5%vs 5%)5%vs 5%)1.1221.1220.3700.370-吸烟吸烟(无无 vs vs 有有)1.0741.0740.5220.522-KPS(80 vs KPS(80 vs 80)80)1.6711.6710.0000.0001.5631.5630.0010.001IIIa vs IIIbIIIa vs IIIb1.2641.2640.0310.0311.2161.2160.0890.089非鳞癌非鳞癌 vs vs 鳞癌鳞癌1.0511.0510.6190.619-Hb(120 vs Hb(120 vs 120 g/L)120 g/L)1.6251.6250.0000.0001.4221.4220.0080.008化学治疗化学治疗 (无无 vs vs 有有)0.8660.8660.1380.138-50-60 vs 60 vs 50-60 vs 60 vs 60 Gy60 Gy0.7850.7850.0010.0010.8520.8520.0460.046常规放疗常规放疗vs vs 三维适形三维适形0.7370.7370.0020.0020.7620.7620.0090.009CR+PR vs SD+PDCR+PR vs SD+PD1.6071.6070.0000.0001.5711.5710.0010.0012020/12/1895局部晚期局部晚期局部晚期局部晚期NSCLCNSCLCNSCLCNSCLC（A/BA/B）3DCRT vs 3DCRT vs 3DCRT vs 3DCRT vs 常规放疗常规放疗常规放疗常规放疗2 D3 DX2P值值例数（比例例数（比例%）例数（比例例数（比例%）食管炎2级135（61.9）180（65.5）0.6560.4502疾8