Wang Si-yu, Zeng Zhi-fan, Ou Wei, Lin Yong-bin, Rong Tie-hua
Department of Thoracic Surgical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Zhong Liu Za Zhi. 2005 Dec;27(12):747-9.
To evaluate the potential reconsideration of curative operative treatment for patients with unresectable stage IIIA (N2) non-small-cell lung cancer (NSCLC).
From Jan. 1999 to Dec. 2002, 76 patients with unresectable stage IIIA (N2) NSCLC were entered in this study. They had all been proved by chest CT, chest film and fiberobronchoscopy. Twenty-one (27.6%) patients were examined by mediastinoscopy. All the patients received two cycles of chemotherapy with NVB (25 mg/m(2), D1, D5) and carboplatin (300 mg/m(2), D1). All the patients were staged again three weeks after induction chemotherapy. Sixty-four patients who achieved partial response (PR) or complete response (CR) were allowed to undergo surgery. Twelve patients who did not responde to chemotherapy received radiotherapy instead. Of the 64 surgically treated patients, 56 (84.7%) had a complete resection and then received 2 cycles of chemotherapy using the same regime, 8 patients had an incomplete resection and then received radiotherapy for the residual tumor.
The median survival for these 76 patients with unresectable stage IIIA (N2) NSCLC treated by either surgery or radiation after induction chemotherapy was 18.6 months with 1-, 2-, 3-year survival rate of 64.2%, 39.4% and 25.6%, respectively. The median survival for the 56 patients with a complete resection was 28.2 months with 1-, 2-, 3-year survival rate of 70.4%, 52.5% and 38.6%, respectively.
Preoperative induction chemotherapy with NVB plus carboplatin should be seriously considered for the patients with unresectable stage IIIA (N2) NSCLC, It is suggested that, whenever possible, surgery should be taken as the first choice for the patients who show down-staged benefits that complete resection can be attempted.
评估对不可切除的IIIA期（N2）非小细胞肺癌（NSCLC）患者进行根治性手术治疗的潜在重新考量。
1999年1月至2002年12月，76例不可切除的IIIA期（N2）NSCLC患者纳入本研究。他们均经胸部CT、胸片和纤维支气管镜检查证实。21例（27.6%）患者接受了纵隔镜检查。所有患者均接受了两个周期的化疗，化疗方案为诺维本（25mg/m²，第1、5天）和顺铂（300mg/m²，第1天）。诱导化疗3周后对所有患者再次进行分期。64例达到部分缓解（PR）或完全缓解（CR）的患者接受手术治疗。12例对化疗无反应的患者改为接受放疗。在64例接受手术治疗的患者中，56例（84.7%）实现了完全切除，随后接受了2个周期的相同方案化疗，8例为不完全切除，随后对残留肿瘤进行了放疗。
这76例不可切除的IIIA期（N2）NSCLC患者在诱导化疗后接受手术或放疗，其总生存期的中位数为18.6个月，1年、2年、3年生存率分别为64.2%、39.4%和25.6%。56例完全切除患者的总生存期中位数为28.2个月，1年、2年、3年生存率分别为70.4%、52.5%和38.6%。
对于不可切除的IIIA期（N2）NSCLC患者，应认真考虑采用诺维本加顺铂进行术前诱导化疗。建议只要有可能，对于显示出降期获益且可尝试进行完全切除的患者，应将手术作为首选治疗方式。
