Sirzén Florin, Kjellén Elisabeth, Sörenson Sverre, Cavallin-Ståhl Eva
Department of Oncology, Karolinska Hospital, Stockholm, Sweden.
Acta Oncol. 2003;42(5-6):493-515. doi: 10.1080/02841860310014453.
A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for non-small cell lung cancer (NSCLC) is based on data from 4 meta-analyses and 31 randomized trials. Moreover, data from 12 prospective studies, 12 retrospective studies and 6 other articles were used. In total, 65 scientific articles are included, involving 18 310 patients. The results were compared with those of a similar overview from 1996 including 28 172 patients. The conclusions reached can be summarized as follows: Extensive clinical experience indicates that radiotherapy for medically inoperable patients or patients refusing surgery with NSCLC stage I/II prolongs survival, 15 -20% of these patients reaching long-term (5-year) survival. However, no randomized trials have addressed this issue. There is strong evidence that postoperative radiotherapy in radically resected stage I/II NSCLC does not prolong survival compared with observation alone. There is some evidence that continuous hyperfractionated accelerated radiotherapy (CHART) is associated with increased survival compared to conventional radiotherapy in locally advanced NSCLC and also in medically unfit patients with stage I/II NSCLC. However, the benefit is limited to squamous cell histology. There is strong evidence that combined modality treatment with platinum-based chemotherapy and radiotherapy, either neoadjuvant or concomitant, is superior to radiotherapy alone in terms of survival in locally advanced unresectable NSCLC and should be the standard of care in patients with good performance status. There is some evidence that concomitant chemo-radiotherapy is associated with increased survival compared with sequential chemo-radiotherapy, albeit at the price of increased toxicity Comment: Combined chemo-radiotherapy of primary non-resectable stage III NSCLC followed by surgery in responders lacks evidence from prospective randomized trials and cannot be recommended for routine use. There is strong evidence that radiotherapy can palliate symptoms associated with the intrathoracic tumour burden. There is some evidence that two large fractions may be as effective as conventional schedules consisting of 10-13 smaller fractions in terms of palliation of symptoms. There is some evidence that endobronchial brachytherapy for palliation of symptoms associated with endobronchial tumours is not superior to external beam radiotherapy.
瑞典卫生保健技术评估委员会（SBU）对多种肿瘤类型的放射治疗试验进行了系统评价。科学文献的评估程序另行描述（《肿瘤学学报》2003年；42: 357 - 365）。本关于非小细胞肺癌（NSCLC）放射治疗的文献综述基于4项荟萃分析和31项随机试验的数据。此外，还使用了12项前瞻性研究、12项回顾性研究和6篇其他文章的数据。总共纳入65篇科学文章，涉及18310例患者。将结果与1996年的一项类似综述进行比较，后者纳入28172例患者。得出的结论可总结如下：丰富的临床经验表明，对医学上无法手术或拒绝手术的I/II期NSCLC患者进行放射治疗可延长生存期，其中15 - 20%的患者可实现长期（5年）生存。然而，尚无随机试验探讨此问题。有强有力的证据表明，与单纯观察相比，I/II期NSCLC根治性切除术后进行放射治疗并不能延长生存期。有一些证据表明，在局部晚期NSCLC以及医学上不适合的I/II期NSCLC患者中，与传统放疗相比，持续超分割加速放疗（CHART）可提高生存率。然而，获益仅限于鳞状细胞组织学类型。有强有力的证据表明，在局部晚期不可切除的NSCLC患者中，以铂类化疗和放疗联合的方式进行新辅助或同步治疗，在生存期方面优于单纯放疗，对于身体状况良好的患者应作为标准治疗方案。有一些证据表明，与序贯放化疗相比，同步放化疗可提高生存率，尽管代价是毒性增加。评论：对不可切除的原发性III期NSCLC患者先进行同步放化疗，然后对缓解者进行手术，缺乏前瞻性随机试验的证据，不建议常规使用。有强有力的证据表明，放射治疗可缓解与胸腔内肿瘤负荷相关的症状。有一些证据表明，就缓解症状而言，两次大剂量分割可能与由10 - 13次较小剂量分割组成的传统方案效果相同。有一些证据表明，支气管内近距离放射治疗缓解支气管内肿瘤相关症状并不优于外照射放疗。
