Mac Manus M P, Wada M, Matthews J P, Ball D L
Department of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):63-9. doi: 10.1016/s0360-3016(99)00357-0.
To investigate the long-term curative potential of radical radiation therapy (RT) for non-small cell lung cancer (NSCLC) by studying characteristics of patients from a large prospective database who survived >5 years after RT, and by analyzing survival beyond 5 years.
Five-year survivors were identified from a database containing information on 488 patients given radical RT following presentation to the Peter MacCallum Cancer Institute with NSCLC between 1984 and 1990. Additional data were obtained from case notes of survivors. RT was computed tomography (CT)-planned, conventionally-fractionated, and given without chemotherapy.
Actuarial survival for 49 5-year survivors was 65% at 10 years. Five 5-year survivors had documented disease progression within the first 5 years and subsequently died. Of 44 patients free-from-progression (FFP) at 5 years, an estimated 81% remained FFP in the second 5 years. Age and histology were not significant prognostic factors, and only 22 patients (4.5%) had weight loss >10%. For 277 patients who had not undergone thoracotomy, median RT dose was 60 Gy and survival at 5 and 10 years was 7% and 3%, respectively. For 207 patients who received radical RT post-thoracotomy, median dose was 60 Gy and survival at 5 and 10 years was 24% and 18%, respectively. Five-year survivors of post-thoracotomy RT had been treated for gross residual disease (n = 10), positive-margin (n = 6), or probable microscopic residual disease (n = 17). Failure to regain ECOG performance status = 0 post-thoracotomy was associated with reduced survival (p<0.0012). FFP in the second 5 years was superior for patients who had postoperative radiotherapy (90%) compared to patients without thoracotomy (62%, p = 0.008).
Most patients FFP >5 years after radical RT for NSCLC remained FFP in the following 5 years and were apparently cured. RT alone can cure small but significant numbers of patients. Long-term results of combined chemotherapy/RT protocols, which are associated with increased median survival, are awaited for comparison.
通过研究一个大型前瞻性数据库中接受根治性放疗（RT）后存活超过5年的非小细胞肺癌（NSCLC）患者的特征，并分析5年后的生存率，来探讨根治性放疗对NSCLC的长期治疗潜力。
从一个数据库中识别出5年生存者，该数据库包含1984年至1990年间因NSCLC就诊于彼得·麦卡勒姆癌症研究所后接受根治性放疗的488例患者的信息。从生存者的病历中获取了额外的数据。放疗采用计算机断层扫描（CT）计划，常规分割，且未进行化疗。
49例5年生存者的精算生存率在10年时为65%。5例5年生存者在最初5年内有记录的疾病进展，随后死亡。在5年时无疾病进展（FFP）的44例患者中，估计81%在第二个5年仍保持FFP。年龄和组织学不是显著的预后因素，只有22例患者（4.5%）体重减轻超过10%。对于277例未接受开胸手术的患者，中位放疗剂量为60 Gy，5年和10年生存率分别为7%和3%。对于207例开胸术后接受根治性放疗的患者，中位剂量为60 Gy，5年和10年生存率分别为24%和18%。开胸术后放疗的5年生存者曾接受过肉眼可见残留病灶（n = 10）、切缘阳性（n = 6）或可能的镜下残留病灶（n = 17）的治疗。开胸术后未能恢复至东部肿瘤协作组（ECOG）体能状态评分为0与生存率降低相关（p<0.0012）。与未接受开胸手术的患者（62%，p = 0.008）相比，接受术后放疗的患者在第二个5年的FFP情况更好（90%）。
大多数NSCLC患者在接受根治性放疗后FFP超过5年，在接下来的5年仍保持FFP，且明显治愈。单纯放疗可治愈一小部分但数量可观的患者。联合化疗/放疗方案的长期结果与中位生存期延长相关，有待进行比较。
