Salvage surgery for local recurrence after carbon ion radiotherapy for patients with lung cancer
Salvage surgery for local recurrence after carbon ion radiotherapy for patients with lung cancer
复制标题
DOI：
10.1093/ejcts/ezv348
复制
发表时间：
2016-05-01
影响因子：
3.4
通讯作者：
Yoshino, Ichiro
中科院分区：
文献类型：
--
作者：
Mizobuchi, Teruaki;Yamamoto, Naoyoshi;Yoshino, Ichiro
目的：碳离子放射治疗（CIRT）有望成为早期非小细胞肺癌（NSCLC）手术治疗的替代方案，即使在可手术患者中也被视为第二佳选择，尽管CIRT后有时会出现局部复发。本研究的目的是调查的人口统计学数据，围手术期的过程和治疗结果的患者谁接受挽救性切除术后局部复发CIRT.METHODS：从1994年11月至2012年2月，CIRT适用于602 c-T1/T2/T3 N 0 M0非小细胞肺癌病灶的599例患者在国立放射科学研究所。共有95例（16%）患者被诊断为局部复发，其中12例接受了挽救手术。结果：有7名男性和5名女性（平均年龄63 ± 7.4岁）。初始表现为NSCLC时的临床分期如下：4例IA、7例IB和1例IIB。所有患者均可手术，但拒绝手术并接受CIRT。CIRT后的中位无进展生存期为20个月（范围，7.1-77个月），在CIRT后的中位24个月（范围，9-78个月）进行挽救手术。所有手术均成功进行，术中无任何严重CIRT相关粘连，未导致死亡或Clavien-Dindo 3-4级术后并发症。病理分期IA 4例，IB 3例，IIB 2例，IIIA 2例，IV 1例，其中6例为CIRT前临床分期的升级。结论：CIRT的剂量强度能保护肺门和壁层胸膜，无1例患者发生射野外粘连，CIRT后局部复发的挽救性手术是安全可行的。
OBJECTIVES: Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT.METHODS: From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed.RESULTS: There were 7 men and 5 women (mean age, 63 +/- 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%.CONCLUSIONS: The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.