RADIATION-THERAPY IN THE MANAGEMENT OF MEDICALLY INOPERABLE CARCINOMA OF THE LUNG - RESULTS AND IMPLICATIONS FOR FUTURE TREATMENT STRATEGIES
RADIATION-THERAPY IN THE MANAGEMENT OF MEDICALLY INOPERABLE CARCINOMA OF THE LUNG - RESULTS AND IMPLICATIONS FOR FUTURE TREATMENT STRATEGIES
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DOI：
10.1016/0360-3016(92)91013-d
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发表时间：
1992-01-01
影响因子：
7
通讯作者：
METKE, MP
中科院分区：
文献类型：
--
作者：
DOSORETZ, DE;KATIN, MJ;METKE, MP
手术是可切除的非小细胞肺癌的首选治疗方法。对于在医学上无法耐受手术切除或拒绝手术的患者，放射治疗是一种可接受的替代方案。我们回顾了1982年至1990年期间在我们机构治疗的152例医学上不能手术的非小细胞肺癌患者的记录。排除转移性疾病、纵隔淋巴结受累或无法切除的肿瘤患者。2年和5年的精算总生存率分别为40%和10%。2年和5年无病生存率分别为31%和15%。T1肿瘤患者2年无病生存率为55%，而T2和T3病变分别为20%和25%（p = 0.0006）。增加肿瘤剂量也与增加无病生存率相关（p = 0.0143）。总体而言，66%的患者被认为失败。其中，70%显示出局部失败的组成部分，45%的失败远。与T2或T3肿瘤患者相比，T1肿瘤患者局部或远处失败的概率较低。局部和远端失败的风险降低，观察到治疗剂量大于65戈瑞的患者，特别是T1肿瘤。我们的结论是，根治性放射治疗是一种有效的治疗小肿瘤时，治疗剂量为65戈瑞或更多。由于局部失败是大肿瘤患者复发的主要模式，因此应考虑对这一患者组采用新的治疗策略。
Surgery is the treatment of choice for resectable non-small cell lung carcinoma. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. We reviewed the records of 152 patients with medically inoperable non-small cell lung carcinoma treated at our institution between 1982 and 1990. Patients with metastatic disease, mediastinal lymph node involvement or unresectable tumors were excluded. The actuarial overall survival at 2 and 5 years was 40% and 10%, respectively. The disease-free survival at 2 and 5 years was 31% and 15%. The disease-free survival for patients with T1 tumors was 55% at 2 years, versus 20 and 25% for T2 and T3 lesions, respectively (p = .0006). Increasing tumor dose was also associated with increasing disease-free survival (p = .0143). Overall, 66% percent of the patients were considered to have failed. Of these, 70% showed a component of local failure and 45% failed distantly. Patients with T1 tumors experienced a lower probability of failing locally or distantly than did patients with T2 or T3 tumors. A reduced risk of local and distant failure was seen for patients treated to doses of greater than 65 Gray, especially for T1 tumors. We conclude that radical radiation therapy is an effective treatment for small tumors when treated to doses of 65 Gray or more. Since local failure is the prominent pattern of relapse in patients with large tumors, new therapeutic strategies should be considered for this patient group.