Vergnon J M, Schmitt T, Alamartine E, Barthelemy J C, Fournel P, Emonot A
Department of Chest Disease and Thoracic Oncology, Saint Etienne University Hospital, France.
Chest. 1992 Nov;102(5):1436-40. doi: 10.1378/chest.102.5.1436.
In unresectable non-small cell lung cancer (NSCLC) with a patent mainstem bronchus, some studies of obstructive tumors, showed (1) a poor role for irradiation in obtaining efficient debulking and (2) an interest in preliminary laser treatment in these patients. Cryotherapy is another method to obtain debulking. Moreover, several studies showed that cryotherapy would increase the radiosensitivity of a tumor. We performed a preliminary protocol combining successively initial cryotherapy followed by irradiation in inoperable NSCLC (either for local or functional contraindications). Thirty-eight patients were included and treated first by cryotherapy performed under general anesthesia and then with external irradiation in a curative intent. The efficiency of cryotherapy assessed on bronchoscopy was found to be volume-efficient (VE) in 26 of the 38 patients and non-volume-efficient (NVE) in the other 12 patients. After irradiation in the VE group, 17 of the 26 patients had no bronchial residual tumor (NRT). In contrast, all of the patients in the NVE group had a bronchial residual tumor (RT). Survival in the VE group (median, 397 days) was significantly higher than the survival of the NVE group (median, 144 days). Survival was found to be independent of the surgical contraindication (local or functional). The best survival was associated both with the efficiency of the initial debulking (VE) by cryotherapy and with the local control (NRT) induced by the irradiation (median, 560 days). Local control was obtained in 65 percent (17/26) of the cases in the VE group and was never observed in the NVE group. In our study the VE group's local control is better than the 35 percent usually reported after irradiation alone. These results argue for the efficient potentiation of irradiation by cryotherapy.
在主支气管通畅的不可切除非小细胞肺癌（NSCLC）中，一些关于阻塞性肿瘤的研究表明：（1）放射治疗在实现有效减瘤方面作用不佳；（2）对这些患者进行初步激光治疗具有一定意义。冷冻疗法是另一种实现减瘤的方法。此外，多项研究表明，冷冻疗法可提高肿瘤的放射敏感性。我们实施了一个初步方案，即先对无法手术的NSCLC（因局部或功能方面的禁忌证）进行冷冻疗法，随后进行放射治疗。纳入了38例患者，首先在全身麻醉下进行冷冻疗法，然后进行根治性的外照射。经支气管镜评估，发现38例患者中有26例冷冻疗法的疗效为体积有效（VE），另外12例为非体积有效（NVE）。VE组放射治疗后，26例患者中有17例无支气管残留肿瘤（NRT）。相比之下，NVE组的所有患者均有支气管残留肿瘤（RT）。VE组的生存期（中位数为397天）显著高于NVE组（中位数为144天）。生存期与手术禁忌证（局部或功能方面）无关。最佳生存期与冷冻疗法初始减瘤的疗效（VE）以及放射治疗诱导的局部控制（NRT）均相关（中位数为560天）。VE组65%（17/26）的病例实现了局部控制，而NVE组未观察到局部控制。在我们的研究中，VE组的局部控制优于通常报道的单纯放射治疗后的35%。这些结果支持冷冻疗法能有效增强放射治疗效果的观点。
