Uy Karl L, Darling Gail, Xu Wei, Yi Qi-Long, De Perrot Marc, Pierre Andrew F, Waddell Thomas K, Johnston Michael R, Bezjak Andrea, Shepherd Frances A, Keshavjee Shaf
Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):188-93. doi: 10.1016/j.jtcvs.2007.01.078.
Optimal management of stage IIIA-N2 non-small cell lung cancer remains controversial. The surgical arm of the North American Intergroup 0139 trial was adopted as the standard treatment for patients with resectable N2 disease at the University Health Network. Results after 7 years of experience are reported.
This is a retrospective study of consecutive patients with biopsy-proved T1-3 N2 M0 lung cancer who underwent induction chemoradiation before surgical intervention from January 1997 through August 2004. Induction chemotherapy consisted of cisplatin, 50 mg/m2, on days 1 and 8; etoposide, 50 mg/m2, on days 1 to 5, weeks 1 and 5; and concurrent daily external beam radiotherapy to 45 Gy. Lung resection was performed within 6 weeks of completion of chemoradiation, followed by 2 further cycles of consolidation chemotherapy.
Between January 1997 and August 2004, 40 patients were treated according to this protocol (25% T1, 62.5% T2, 7.5% T3, and 5% T4). Overall and disease-free median survivals were 40 and 37.1 months, respectively, whereas overall and disease-free 3-year survivals were 51.7% and 52.3%, respectively. R0 resection was achieved in 92.5%. The overall operative mortality rate was 7.5% (0% for lobectomy and 27% for pneumonectomy). Notably, all mortalities occurred within the first 2 years of our experience with this regimen.
Chemoradiation before pulmonary resection in carefully selected patients with surgically resectable stage IIIA (N2) non-small cell lung cancer can lead to improved overall and disease-free survival.
IIIA-N2期非小细胞肺癌的最佳治疗方案仍存在争议。北美肿瘤协作组0139试验的手术治疗方案被用作大学健康网络中可切除N2期疾病患者的标准治疗方法。本文报告了7年的经验结果。
这是一项对1997年1月至2004年8月期间接受手术干预前经活检证实为T1-3 N2 M0肺癌的连续患者的回顾性研究。诱导化疗包括顺铂（50mg/m²，第1天和第8天）、依托泊苷（50mg/m²，第1至5天，第1周和第5周），并同时进行每日45Gy的外照射放疗。在放化疗完成后6周内进行肺切除术，随后再进行2个周期的巩固化疗。
1997年1月至2004年8月期间，40例患者按照该方案接受治疗（25%为T1，62.5%为T2，7.5%为T3，5%为T4）。总中位生存期和无病中位生存期分别为40个月和37.1个月，3年总生存率和无病生存率分别为51.7%和52.3%。R0切除率为92.5%。总手术死亡率为7.5%（肺叶切除术为零，全肺切除术为27%）。值得注意的是，所有死亡均发生在我们采用该方案治疗的头2年内。
对于精心挑选的可手术切除的IIIA（N2）期非小细胞肺癌患者，肺切除术前进行放化疗可提高总生存期和无病生存期。
