Allen Aaron M, Mentzer Steven J, Yeap Beow Y, Soto Ricardo, Baldini Elizabeth H, Rabin Michael S, Sugarbaker David J, Bueno Raphael
Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA 02115, USA.
Cancer. 2008 Mar 1;112(5):1106-13. doi: 10.1002/cncr.23283.
The current study was conducted to examine the outcomes of pneumonectomy after induction chemoradiotherapy in patients with locally advanced nonsmall cell lung cancer (NSCLC).
All patients undergoing pneumonectomy after induction therapy at the Brigham and Women's Hospital were retrospectively evaluated for 30-day and 100-day mortality and treatment-related complications with Institutional Review Board approval. Multivariate and univariate analyses for clinical factors correlating with toxicity and/or survival were calculated.
Between 1995 and 2005, 73 patients underwent pneumonectomy for NSCLC after induction therapy. All patients received radiation (median dose of 54 gray [Gy]) and 69 patients (95%) received concurrent chemotherapy. The median age was 62 years and 43 patients (59%) were male; Thirty-seven patients (51%) had American Joint Committee on Cancer stage IIIA NSCLC, 27 (37%) had stage IIIB, 6 had stage IIB, and 4 had stage IV NSCLC because of a resected solitary brain metastasis. A majority (44; 60%) of patients received the combination of carboplatin and paclitaxel, whereas 15 (21%) received the combination of cisplatin and etoposide. Forty-five patients (62%) underwent left pneumonectomy. With a median follow-up of 28 months, the 1-year and 2-year overall survival rates were 70% and 49%, respectively. The 30-day and 100-day mortality rates were 6% and 10%, respectively. Only 4 of 73 patients (6%) died of acute respiratory distress syndrome. The rate of nonfatal treatment-related morbidity was 11%. On univariate analysis, right-sided pneumonectomy was associated with a higher risk of treatment-related mortality (P = .099).
With an acceptable mortality rate, a single-institutional series demonstrated that trimodality therapy including pneumonectomy can be safely accomplished in patients with advanced NSCLC.
本研究旨在探讨局部晚期非小细胞肺癌（NSCLC）患者诱导放化疗后肺切除术的疗效。
在获得机构审查委员会批准后，对所有在布莱根妇女医院接受诱导治疗后行肺切除术的患者进行回顾性评估，以确定其30天和100天死亡率以及与治疗相关的并发症。计算与毒性和/或生存相关的临床因素的多变量和单变量分析。
1995年至2005年期间，73例患者在诱导治疗后因NSCLC接受了肺切除术。所有患者均接受了放疗（中位剂量为54格雷[Gy]），69例患者（95%）接受了同步化疗。中位年龄为62岁，43例患者（59%）为男性；37例患者（51%）患有美国癌症联合委员会IIIA期NSCLC，27例（37%）患有IIIB期，6例患有IIB期，4例因切除孤立性脑转移而患有IV期NSCLC。大多数患者（44例；60%）接受了卡铂和紫杉醇联合治疗，而15例（21%）接受了顺铂和依托泊苷联合治疗。45例患者（62%）接受了左肺切除术。中位随访28个月，1年和2年总生存率分别为70%和49%。30天和100天死亡率分别为6%和10%。73例患者中只有4例（6%）死于急性呼吸窘迫综合征。非致命性治疗相关发病率为11%。单变量分析显示，右侧肺切除术与治疗相关死亡率较高相关（P = 0.099）。
在一个单机构系列研究中，肺切除术等三联疗法在晚期NSCLC患者中可以安全完成，死亡率可接受。
