Dosoretz D E, Katin M J, Blitzer P H, Rubenstein J H, Salenius S, Rashid M, Dosani R A, Mestas G, Siegel A D, Chadha T T
Radiation Therapy Regional Center, Fort Myers, FL.
Int J Radiat Oncol Biol Phys. 1992;24(1):3-9. doi: 10.1016/0360-3016(92)91013-d.
Surgery is the treatment of choice for resectable non-small cell lung carcinoma. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. We reviewed the records of 152 patients with medically inoperable non-small cell lung carcinoma treated at our institution between 1982 and 1990. Patients with metastatic disease, mediastinal lymph node involvement or unresectable tumors were excluded. The actuarial overall survival at 2 and 5 years was 40% and 10%, respectively. The disease-free survival at 2 and 5 years was 31% and 15%. The disease-free survival for patients with T1 tumors was 55% at 2 years, versus 20 and 25% for T2 and T3 lesions, respectively (p = .0006). Increasing tumor dose was also associated with increasing disease-free survival (p = .0143). Overall, 66% percent of the patients were considered to have failed. Of these, 70% showed a component of local failure and 45% failed distantly. Patients with T1 tumors experienced a lower probability of failing locally or distantly than did patients with T2 or T3 tumors. A reduced risk of local and distant failure was seen for patients treated to doses of greater than 65 Gray, especially for T1 tumors. We conclude that radical radiation therapy is an effective treatment for small tumors when treated to doses of 65 Gray or more. Since local failure is the prominent pattern of relapse in patients with large tumors, new therapeutic strategies should be considered for this patient group.
手术是可切除非小细胞肺癌的首选治疗方法。对于因身体原因无法耐受手术切除或拒绝手术的患者，放射治疗是一种可接受的替代方案。我们回顾了1982年至1990年间在我院接受治疗的152例因身体原因无法手术的非小细胞肺癌患者的记录。排除有转移性疾病、纵隔淋巴结受累或不可切除肿瘤的患者。2年和5年的精算总生存率分别为40%和10%。2年和5年的无病生存率分别为31%和15%。T1期肿瘤患者的2年无病生存率为55%，而T2期和T3期病变分别为20%和25%（p = .0006）。增加肿瘤剂量也与无病生存率的提高相关（p = .0143）。总体而言，66%的患者被认为治疗失败。其中，70%表现为局部失败，45%为远处失败。T1期肿瘤患者局部或远处失败的概率低于T2期或T3期肿瘤患者。接受大于65格雷剂量治疗的患者局部和远处失败风险降低，尤其是T1期肿瘤患者。我们得出结论，根治性放射治疗对于接受65格雷或更高剂量治疗的小肿瘤是一种有效的治疗方法。由于局部失败是大肿瘤患者复发的主要模式，对于这组患者应考虑新的治疗策略。
