Cicenas Saulius, Piscikas Dainius Amerigas, Jakubauskiene Renata
Institute of Oncology, Vilnius University, Santariskiu 1, 2021 Vilnius, Lithuania.
Medicina (Kaunas). 2004;40 Suppl 1:156-60.
The aim of the study was: to evaluate efficacy of postoperative chemotherapy and chemoradiotherapy in patients with NSCLC (N2) disease and to point out time to tumor progression and reccurence, as well as to patients survival. Study was performed as a part of International Adjuvant Lung Cancer Treatment (IALT) protocol. In 1999-2000, 110 patients patients with NSCLC with metastases to N1 and N2 regions entered the trial. Patients were randomized for investigonal group: postoperative chemotherapy 31 patients (48.4%), and chemoradiotherapy 34 patients (53.1%). These patients were compared to 45 patients who underwent only surgery (control group). Patients in the first group according to stages were: II A st. 30 patients (46.1%), IIB - 6 patients. (9.2%), IIIA st. 29 patients (44.6%). Morphology: squamos cell 44 patients (67.6%) and adeno 16 patients (24.6%).
lobectomy - 20 patients (30.7%), bilobectomy - 6 patients (9.2%), pleuropneumonectomy 13 patients (20%), combined pneumonectomy 13 patients (20%), pneumonectomy 12 patients (18.4%). Chemotherapy started within 60 days after operation. Radiation started in 10 days after last cycle of chemotherapy.
Postoperatively 42.8% patients had reccurences after pneumonectomy. In surgery group 26.6% patients had reccurences in 3-year period. Medial survival in adjuvant group was 21.3 months. In surgery group three-year survival was in 19.7% of patients, chemoradiation group - 42.4%, and chemotherapy group - 37.2%.
Postoperative adjuvant therapy remains unsolved and controversal problem. Neither chemotherapy, nor chemoradiotherapy has real impact on survival: 3-year survival in surgery group was observed in 19.7%, in chemoradiation - 42.2%, and in chemotherapy group in 37.2% of patients. Efficacy of postoperative treatment depends on radical removal of lymphodes, tumor morphology and postoperative complications.
本研究的目的是：评估非小细胞肺癌（N2）患者术后化疗和放化疗的疗效，并指出肿瘤进展和复发时间以及患者生存率。该研究作为国际辅助肺癌治疗（IALT）方案的一部分进行。1999年至2000年，110例N1和N2区域有转移的非小细胞肺癌患者进入试验。患者被随机分为研究组：术后化疗31例（48.4%），放化疗34例（53.1%）。将这些患者与45例仅接受手术的患者（对照组）进行比较。第一组患者按分期为：IIA期30例（46.1%），IIB期6例（9.2%），IIIA期29例（44.6%）。形态学类型：鳞状细胞癌44例（67.6%），腺癌16例（24.6%）。
肺叶切除术20例（30.7%），双肺叶切除术6例（9.2%），胸膜肺切除术13例（20%），联合肺切除术13例（20%），全肺切除术12例（18.4%）。化疗在术后60天内开始。放疗在最后一个化疗周期后10天开始。
全肺切除术后42.8%的患者出现复发。手术组26.6%的患者在3年内出现复发。辅助治疗组的中位生存期为21.3个月。手术组3年生存率为19.7%的患者，放化疗组为42.4%，化疗组为37.2%。
术后辅助治疗仍然是一个未解决且有争议的问题。化疗和放化疗对生存率均无实际影响：手术组3年生存率为19.7%，放化疗组为42.2%，化疗组为37.2%的患者。术后治疗效果取决于淋巴结的彻底清除、肿瘤形态和术后并发症。
