Neoadjuvant chemotherapy in marginally resectable stage III M0 non‐small cell lung cancer: Long‐term follow‐up in 41 patients
Neoadjuvant chemotherapy in marginally resectable stage III M0 non‐small cell lung cancer: Long‐term follow‐up in 41 patients
复制标题
可边缘切除的 III 期 M0 非小细胞肺癌的新辅助化疗：41 名患者的长期随访
作者：
A. Skarin;M. Jochelson;T. Sheldon;A. Malcolm;P. Oliynyk;R. Overholt;M. Hunt;E. Frei
41例可边缘切除的III期M0非小细胞肺癌（NSCLC）患者入组一项研究，评价新辅助环磷酰胺、阿霉素和顺铂化疗（CAP），随后进行放疗和后续切除。还进行了术后放疗和额外的CAP。术前客观疾病消退率为72%（2例完全缓解，12例部分缓解，7例轻微缓解）。37例患者（90%）进行了开胸手术，36例患者（97%）切除了所有肉眼可见的疾病。复发发生在22例（61%）切除的患者，涉及胸部（4例），胸部和胸外（9例），胸外（9例）。在36例术后患者中，9例（25%）发生了随后的CNS复发，与其他复发部位（5例患者）或单独复发部位（4例患者）相关。接受预防性颅照射（PCI）的7例患者中只有1例发生CNS复发，而未接受PCI的27例患者中有7例（26%）发生CNS复发。14例存活患者的中位长期随访时间为53 +个月，范围为38 +至71 +个月。所有患者的中位生存期为32个月，1年生存率为75%。生存曲线显示从3年到5年以上的平台为31%。使用对数秩检验，未发现显著影响缓解率、无病生存期或总生存期的预后亚组。虽然新辅助CAP后放疗似乎可以提高生存率，但需要更有效的化疗沿着随机研究来确定初始化疗在边缘可切除NSCLC中的作用。
Forty‐one patients with marginally resectable stage III M0 non‐small cell lung cancer (NSCLC) were entered into a study evaluating neoadjuvant cyclophosphamide, adriamycin, and cisplatin chemotherapy (CAP) followed by radiotherapy and subsequent resection. Postoperative radiotherapy and additional CAP were also administered. The objective disease regression rate prior to surgery was 72% (2 complete, 12 partial, and 7 minimal responses). Thoracotomy was carried out in 37 patients (90%), with resection of all gross disease in 36 patients (97%). Relapse occurred in 22 (61%) of the resected patients, involving chest only (four patients), chest and extra thoracic (nine patients), and extra thoracic only (nine patients). Subsequent CNS relapse developed in 9 (25%) of 36 postop patients in association with other sites of relapse (five patients) or as a solitary location (four patients). Only one of seven patients receiving prophylactic cranial irradiation (PCI) developed CNS relapse compared with 7 (26%) of 27 patients not receiving PCI. The median long‐term follow‐up for 14 living patients is 53 + months, with a range of 38 + to 71 + months. Median survival for all patients is 32 months, with 1‐year survival being 75%. The survival curve shows a plateau of 31% from 3 to 5 + years. Using a log rank test, no prognostic subgroups could be identified that significantly affected response rate, disease‐free survival, or overall survival. While neoadjuvant CAP followed by radiotherapy appears to improve survival, more effective chemotherapy along with randomized studies are needed to determine the role of initial chemotherapy in marginally resectable NSCLC.
影响因子：
45.3
作者：
ANDERSON, JR;CAIN, KC;GELBER, RD
通讯作者：
GELBER, RD
影响因子：
120.7
作者：
COX, JD;STANLEY, K;YESNER, R
通讯作者：
YESNER, R