Zierhut D, Bettscheider C, Schubert K, van Kampen M, Wannenmacher M
Department of Clinical Radiology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Lung Cancer. 2001 Dec;34 Suppl 3:S39-43. doi: 10.1016/s0169-5002(01)00381-6.
Surgery is the preferred and standard treatment for patients with resectable stage I and II non-small cell lung cancer (NSCLC). Survival rates of local surgery are unbeaten by other treatment modalities. Up to 70% of these patients survive 5 years or longer. However, there is a subset of patients who either are inoperable due to the presence of severe associated diseases, or who refuse surgery. In these patients radical radiotherapy with curative intent is an effective alternative. In our department we retrospectively analysed survival and freedom from treatment failure in those patients treated in our hospital with primary irradiation for stage I and II NSCLC (T1-2 N0-1 M0) during the last 20 years. In total 60 patients with a median age of 69 years could be evaluated. 35% had stage I and 65% had stage II NSCLC. All patients received 2- or 3-dimensionally planned megavoltage radiotherapy with a median dose of 60 Gy with normally fractionated single doses of 2.0 Gy five times a week. Pneumonitis WHO Grade III was found in 5 out of the 60 patients (8.3%). Locoregional recurrence was observed in 53% of the patients resulting in a median progression-free survival of 18 months and a median overall survival of 20.5 months. However, there is a need for further improvement of treatment outcome of radiotherapy for medically inoperable patients with early-stage NSCLC. One possibility might be radiation dose escalation or alteration in fractionation of radiotherapy, such as continuous hyperfractionated accelerated radiotherapy CHART or a modification thereof CHARTWEL. These new fractionation schemes might be beneficial for a subset of patients in terms of improved local control, reduced incidence of metastasis and improved long term survival. The combination of chemotherapy and radiotherapy might be another option for treatment of early-stage NSCLC. In advanced disease combined modality treatment turned out to be superior to radiotherapy alone, concerning local control and survival. If this is true also for early-stage NSCLC, it has to be shown in further investigations.
手术是可切除的Ⅰ期和Ⅱ期非小细胞肺癌（NSCLC）患者的首选和标准治疗方法。局部手术的生存率优于其他治疗方式。这些患者中高达70%可存活5年或更长时间。然而，有一部分患者要么因存在严重的相关疾病而无法手术，要么拒绝手术。对于这些患者，根治性放疗是一种有效的替代方法。在我们科室，我们回顾性分析了过去20年内在我院接受Ⅰ期和Ⅱ期NSCLC（T1-2 N0-1 M0）原发照射治疗的患者的生存情况及无治疗失败生存期。总共评估了60例患者，中位年龄为69岁。35%为Ⅰ期NSCLC，65%为Ⅱ期NSCLC。所有患者均接受了二维或三维计划的兆伏级放疗，中位剂量为60 Gy，通常每周分5次给予单次剂量2.0 Gy。60例患者中有5例（8.3%）出现了世界卫生组织Ⅲ级肺炎。53%的患者出现了局部区域复发，导致无进展生存期的中位时间为18个月，总生存期的中位时间为20.5个月。然而，对于医学上无法手术的早期NSCLC患者，放疗的治疗效果仍需进一步改善。一种可能性可能是提高放疗剂量或改变放疗分割方式，如连续超分割加速放疗（CHART）或其改良方案（CHARTWEL）。这些新的分割方案可能对一部分患者有益，可改善局部控制、降低转移发生率并提高长期生存率。化疗和放疗联合可能是早期NSCLC治疗的另一种选择。在晚期疾病中，联合治疗在局部控制和生存方面被证明优于单纯放疗。对于早期NSCLC是否也是如此，还需要进一步的研究来证实。
