LOCAL-CONTROL IN MEDICALLY INOPERABLE LUNG-CANCER - AN ANALYSIS OF ITS IMPORTANCE IN OUTCOME AND FACTORS DETERMINING THE PROBABILITY OF TUMOR-ERADICATION
LOCAL-CONTROL IN MEDICALLY INOPERABLE LUNG-CANCER - AN ANALYSIS OF ITS IMPORTANCE IN OUTCOME AND FACTORS DETERMINING THE PROBABILITY OF TUMOR-ERADICATION
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DOI：
10.1016/0360-3016(93)90373-4
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发表时间：
1993-10-20
影响因子：
7
通讯作者：
METKE, MP
中科院分区：
文献类型：
--
作者：
DOSORETZ, DE;GALMARINI, D;METKE, MP
目的：对于在医学上无法耐受手术切除技术上可切除的非小细胞肺癌的患者，放射治疗是可接受的替代方案。我们报告的影响，实现局部控制的原发性肿瘤的生存终点，并分析可能影响局部control.Methods和材料的因素：我们回顾了152例医学上不能手术的非小细胞肺癌在我们的机构治疗的记录。所有患者都有技术上可切除的病变，没有转移性疾病的证据。治疗采用兆伏照射，剂量范围为45至75戈伊。结果：对于肿瘤3 cm或更小的患者，局部控制肿瘤显著提高生存率（p = 0.0371）。如果原发性肿瘤得到局部控制，则T1肿瘤患者的生存概率和无病生存率高于较大肿瘤患者，但如果肿瘤未得到控制，则这种生存优势消失。总体而言，肿瘤较小的患者远端扩散的发生率较低，但只有当原发性肿瘤得到控制时，这种相关性才得以维持（肿瘤< 3 cm，3-4.9 cm，5 cm或更大的36个月风险分别为10%，23%和57%，p = 0.0027）。对于肿瘤未得到控制的患者，肿瘤大小对远处转移的风险没有显著差异。较高的辐射剂量影响局部控制和转移扩散。我们观察到没有影响的初始字段大小的风险，局部控制和概率survival.Conclusion：根治性放射治疗是一种有效的治疗小（T1或< 3 cm）肿瘤时，治疗剂量为65戈伊或以上，并应提供作为一种替代手术在老年人或体弱患者。对于较大的肿瘤，应考虑通过超分割治疗、支气管内“加强”照射和增敏化疗药物来提高局部控制率的新治疗策略。
Purpose: For patients who are medically unable to tolerate a surgical resection for technically resectable non-small-cell lung carcinoma, radiation therapy is an acceptable alternative. We report on the effect of achieving local control of the primary tumor on survival end-points, and analyze factors that may influence local control.Methods and Materials: We reviewed the records of 152 patients with medically inoperable non-small-cell lung carcinoma treated at our institutions. All patients had technically resectable lesions and no evidence of metastatic disease. Treatment was delivered using megavoltage irradiation to doses ranging from 45 to 75 Gy.Results: For patients with tumors 3 cm or less, locally controlling the tumor significantly improved survival (p = .0371). Patients with Tl tumors had a higher probability of survival and disease-free-survival than patients with larger tumors if the primary tumor was locally controlled, but this survival advantage disappeared if the tumor was not controlled. Overall, patients with smaller tumors had a lower incidence of distant spread, but this association was maintained only when the primary tumor was controlled (36 month risk of 10%, 23%, and 57% for tumors < 3 cm, 3-4.9 cm, 5 cm or greater, respectively, p = .0027). For patients whose tumors were not controlled, there was no significant difference in the risk of distant dissemination by tumor size. Higher radiation doses influenced local control and metastatic spread. We observed no influence of the initial field size in the risk of local control and in the probability of survival.Conclusion: Radical radiation therapy is an effective treatment for small (T1 or < 3 cm) tumors when treated to doses of 65 Gy or more, and should be offered as an alternative to surgery in elderly or infirm patients. New therapeutic strategies to improve the local control rate should be considered for larger tumors, through the use of hyperfractionated treatment, endobronchial ''boost'' irradiation, and sensitizing chemotherapy agents.