Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer
Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer
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DOI：
10.1016/j.jtcvs.2004.09.025
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发表时间：
2005-02-01
影响因子：
6
通讯作者：
Landreneau, RJ
中科院分区：
文献类型：
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作者：
Fernando, HC;Santos, RS;Landreneau, RJ
目的：计算机断层扫描筛查正在检测更小的外周非小细胞肺癌。这些较小的癌症适合进行亚肺叶切除术，但亚肺叶切除术目前并不是首选的治疗方法。本研究比较了 IA 期非小细胞肺癌的亚肺叶切除术与肺叶切除术，以评估亚肺叶切除术是否适合某些病变的治疗。还对辅助近距离放射治疗的使用进行了评估。方法：对 291 名 T1 NO 疾病患者进行了回顾性多中心研究。将亚肺叶切除术后的结果 (n = 124) 与肺叶切除术后的结果 (n = 167) 进行比较。近距离放射治疗与 60 例 (48%) 亚肺叶切除手术结合使用。根据肿瘤直径进行分析。结果：小于2厘米的癌症有137个，2至3厘米的癌症有154个。接受亚肺叶切除术的患者年龄较大（68.4 岁 vs 66.1 岁，P = 0.018），肺功能较差（第 1 秒用力呼气量分别为 53.1% vs 78.2%，P = 0.001）。平均随访时间为 34.5 个月。近距离放射治疗显着降低了接受亚肺叶切除术的患者的局部复发率，从 I (17.2%) 降至 2 (3.3%)。对于小于2厘米的肿瘤，亚肺叶切除组和肺叶切除组之间的生存率没有差异。对于较大的肿瘤（2-3 cm），肺叶切除组的中位生存期明显更好，分别为 70 个月和 44.7 个月 (P = 0.003)。结论：术中近距离放射治疗可以减少亚肺叶切除术中通常报告的局部复发。我们的经验支持进一步研究使用亚肺叶切除联合近距离放射治疗治疗小于 2 cm 的外周 IA 期非小细胞肺癌。
Objective: Computed tomographic screening is detecting ever smaller peripheral non-small cell lung cancers. These smaller cancers are amenable to sublobar resection, but sublobar resection is not currently the treatment of choice. This study compared sublobar resection with lobar resection for stage IA non-small cell lung cancers to assess whether sublobar resection is appropriate treatment for certain lesions. The use of adjuvant brachytherapy was also evaluated.Methods: A retrospective multicenter study of 291 patients with T1 NO disease was done. Outcomes after sublobar resection (n = 124) were compared with those after lobar resection (n = 167). Brachytherapy was used in conjunction with 60 (48%) sublobar resection operations. Analysis based on tumor diameter was performed.Results: There were 137 cancers smaller than 2 cm and 154 cancers ranging from 2 to 3 cm. Patients undergoing sublobar resection were older (68.4 vs 66.1 years, P =.018) with poorer pulmonary function (forced expiratory volume in I second of 53.1% vs 78.2%, P =.001). Mean follow-up was 34.5 months. Brachytherapy decreased local recurrence rate significantly among patients undergoing sublobar resection, from I I (17.2%) to 2 (3.3%). For tumors smaller than 2 cm, there was no difference in survival between sublobar resection and lobar resection groups. For the larger tumors (2-3 cm), median survival was significantly better in the lobar resection group, at 70 versus 44.7 months (P =.003).Conclusion: Intraoperative brachytherapy may reduce the local recurrence that is usually reported with sublobar resection. Our experience supports the further investigation of the use of sublobar resection with brachytherapy for peripheral stage IA non-small cell lung cancers smaller than 2 cm.