Decker Roy H, Wilson Lynn D
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Semin Thorac Cardiovasc Surg. 2008 Fall;20(3):184-7. doi: 10.1053/j.semtcvs.2008.09.004.
Adjuvant chemotherapy is now standard therapy following resection of large or locally advanced non-small cell lung cancer (NSCLC), with improvement in survival demonstrated in multiple randomized trials. Despite this, disease recurrence following optimal surgery and adjuvant systemic therapy is common. For patients with locally advanced disease, the majority will have a recurrence within the chest, most commonly at the bronchial stump or in hilar or mediastinal lymphatics. Postoperative radiation therapy (PORT) has been shown to decrease local and regional recurrences, an effect noted most clearly in stage N2 patients and those with positive surgical margins. An improvement in overall survival, similar to that following adjuvant chemotherapy, has not been consistently noted due to a high risk of treatment-related normal tissue toxicity in trials conducted over several decades. Improvements in radiation technique appear to have decreased the toxicity of PORT in more modern series, presumably increasing the potential benefit.
辅助化疗现已成为大型或局部晚期非小细胞肺癌（NSCLC）切除术后的标准治疗方法，多项随机试验证明其可提高生存率。尽管如此，在进行了最佳手术和辅助全身治疗后，疾病复发仍很常见。对于局部晚期疾病患者，大多数会在胸部复发，最常见于支气管残端或肺门或纵隔淋巴管。术后放疗（PORT）已被证明可减少局部和区域复发，这一效果在N2期患者和手术切缘阳性的患者中最为明显。由于几十年来进行的试验中与治疗相关的正常组织毒性风险很高，因此尚未一致观察到与辅助化疗后相似的总生存期改善。在更现代的系列研究中，放疗技术的改进似乎降低了PORT的毒性，推测这增加了潜在益处。
