SURGICAL RESECTION OF STAGE-IIIA AND STAGE-IIIB NON-SMALL-CELL LUNG-CANCER AFTER CONCURRENT INDUCTION CHEMORADIOTHERAPY - A SOUTHWEST-ONCOLOGY-GROUP TRIAL
SURGICAL RESECTION OF STAGE-IIIA AND STAGE-IIIB NON-SMALL-CELL LUNG-CANCER AFTER CONCURRENT INDUCTION CHEMORADIOTHERAPY - A SOUTHWEST-ONCOLOGY-GROUP TRIAL
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DOI：
10.1016/s0022-5223(19)33853-x
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发表时间：
1993-01-01
影响因子：
6
通讯作者：
BENFIELD, JR
中科院分区：
文献类型：
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作者：
RUSCH, VW;ALBAIN, KS;BENFIELD, JR
最近的研究表明，术前诱导化疗+/-放疗可以改善历史上IIIA期非小细胞肺癌患者的可切除性和生存率，但有时与显着相关的发病率和死亡率。这种治疗尚未在IIIB期非小细胞肺癌中进行过研究，通常被认为是不可切除的。这项多机构II期试验测试了IIIA和IIIB期非小细胞肺癌术前同步放化疗的可行性。方法.符合条件的患者有病理学记录的T1-4 N2-3疾病（无胸腔积液）。诱导治疗为顺铂，50 mg/m2，第1、8、29和36天，加上V-P-16，50 mg/m2，第1 - 5天和29 - 33天，加上同步放疗（4500 cGy，180 cGy分次）。如果反应稳定、部分或完全，则在诱导后3至5周尝试切除。开胸时需要进行完整的淋巴结标测。结果：146例患者入组。这项中期分析是基于前75名有完整手术数据的合格患者。有49名男性和26名女性，中位年龄58岁（范围32至75岁）。68/75例（91%）患者符合手术条件，63/75例（84%）患者接受了手术。开胸手术75例患者中有55例（73%），包括16例稳定反应的12例，完全切除。63例患者中有4例术后死亡（6%）。大约三分之一需要“复杂”切除术，例如，肺叶切除术加胸壁或脊柱切除术，但平均手术时间为3.2小时，IIIA和IIIB期的平均失血量均小于1000 ml。目前可从53例患者获得完整的病理学数据：11例（21%）无残留肿瘤; 20例（30%）有罕见的显微镜下残留癌灶。IIIA和IIIB期的2年生存率均为40%。结论.这种联合治疗耐受性良好，在IIIA期和IIIB期非小细胞肺癌中均具有高缓解率和可切除率。目前的生存率明显优于历史对照患者的生存率，为后续III期临床试验提供了坚实的基础。
Recent studies suggest that preoperative induction chemotherapy +/- radiotherapy can improve the historically poor resectability and survival of patients with stage IIIA non-small-cell lung cancer, but sometimes with significant associated morbidity and mortality. Such treatment has not been studied in stage IIIB non-small-cell lung cancer, usually considered unresectable. This multiinstitutional phase II trial tested the feasibility of concurrent preoperative chemoradiotherapy for stages IIIA and IIIB non-small-cell lung cancer. Methods. Eligible patients had pathologically documented T1-4 N2-3 disease (without pleural effusions). Induction therapy was cisplatin, 50 mg/m2, days 1, 8, 29, and 36 plus V-P-16, 50 mg/m2, days 1 to 5, and 29 to 33 plus concurrent radiotherapy (4500 cGy, 180 cGy fractions). Resection was attempted 3 to 5 weeks after induction if the response was stable, partial, or complete. Complete nodal mapping at thoracotomy was required. Results: One hundred forty-six patients were entered. This interim analysis is based on the first 75 eligible patients for whom complete surgical data are available. There were 49 men and 26 women, median age 58 years (range 32 to 75 years). Sixty-eight of 75 (91 %) patients were eligible for operation, and 63 of 75 patients (84 %) underwent. thoracotomy. Fifty five of 75 patients (73 %), including 12 of 16 with a stable response, had a complete resection. Four of 63 patients died postoperatively (6 %). Approximately one third required a ''complex'' resection, for example, lobectomy plus chest wall or spine resection, but mean operating time was 3.2 hours and mean blood loss was less than 1000 ml for both stages IIIA and IIIB. Complete pathology data are currently available from 53 patients: 11 (21 %) had no residual tumor; 20 (30 %) had rare microscopic foci of residual cancer. The 2-year survival is 40 % for both stages IIIA and IIIB. Conclusions. This combined modality therapy has been well tolerated and has been associated with high response and resectability rates in both stage IIIA and stage IIIB non-small-cell lung cancer. Current survival is significantly better than survivorship among historical control patients and provides a firm basis for subsequent phase III clinical trials.