Marra A, Eberhardt W, Pöttgen C, Theegarten D, Korfee S, Gauler T, Stuschke M, Stamatis G
Dept of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Tueschener Weg 40, 45239 Essen, Germany.
Eur Respir J. 2007 Jan;29(1):117-26. doi: 10.1183/09031936.00108205. Epub 2006 Sep 13.
The traditional treatment of Pancoast tumour with local approaches (surgery, radiotherapy or a combination of both) leads to a poor outcome due to the high rate of incomplete resection and the lack of systemic control. The aim of the present prospective feasibility study was to determine whether a trimodality approach improves local control and survival. Patients with stage IIB-IIIB Pancoast tumour received induction chemotherapy (three courses of split-dose cisplatin and etoposide or paclitaxel) followed by concurrent chemoradiotherapy (a course of cisplatin/etoposide combined with 45 Gy hyperfractionated accelerated radiotherapy). After restaging, eligible patients underwent surgery 4-6 weeks post-radiation. A total of 31 consecutive patients with T3 (81%) or T4 (19%) Pancoast tumour were enrolled in the study. Induction chemoradiotherapy was completed in all patients without treatment-related deaths. Grade 3-4 toxicity was observed in 32% of cases. In total, 29 (94%) patients were eligible for surgery. Complete resection was achieved in 94% of patients. The post-operative mortality rate was 6.4% and major complications arose in 20.6% of the patients. The median survival was 54 months with 2- and 5-yr survival rates of 74 and 46%, respectively. In conclusion, this intensive multimodality treatment of Pancoast tumour is feasible and improves local resectability rates and long-term survival as compared with historical series.
采用局部治疗方法（手术、放疗或两者联合）传统治疗肺上沟瘤，由于不完全切除率高且缺乏全身控制，导致预后较差。本前瞻性可行性研究的目的是确定三联疗法是否能改善局部控制和生存率。IIB-IIIB期肺上沟瘤患者接受诱导化疗（三个疗程的分剂量顺铂和依托泊苷或紫杉醇），随后进行同步放化疗（一个疗程的顺铂/依托泊苷联合45 Gy超分割加速放疗）。重新分期后，符合条件的患者在放疗后4-6周接受手术。共有31例连续的T3（81%）或T4（19%）肺上沟瘤患者纳入本研究。所有患者均完成诱导放化疗，无治疗相关死亡。32%的病例观察到3-4级毒性。总共29例（94%）患者符合手术条件。94%的患者实现了完全切除。术后死亡率为6.4%，20.6%的患者出现严重并发症。中位生存期为54个月，2年和5年生存率分别为74%和46%。总之，与历史系列相比，这种强化多模式治疗肺上沟瘤是可行的，并且提高了局部可切除率和长期生存率。
