Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois 60612, USA.
J Thorac Oncol. 2011 Jun;6(6):1079-86. doi: 10.1097/JTO.0b013e3182199a7c.
Concurrent chemoradiotherapy (CRT) is a standard of care in the treatment of unresectable locally advanced non-small cell lung cancer (NSCLC). At Rush University Medical Center, patients with locally advanced NSCLC are treated with split-course CRT in an attempt to maximize efficacy and tolerability. We reviewed our experience in advanced NSCLC since 1999. Subset analysis was performed on poor-risk patients.
All patients with a diagnosis of stage IIIA/IIIB NSCLC and treated with definitive split-course CRT between January 1999 and December 2008 were included in this retrospective study. The primary end point was overall survival. Poor-risk patients were defined in accordance with ongoing cooperative group trials.
One hundred forty-four patients were identified, 35% stage IIIA and 65% stage IIIB. There were 52 poor-risk patients and 92 average-risk patients. Median survival for all patients was 20.4 months with an actuarial 32.1% 3-year overall survival rate. Poor-risk patients demonstrated a median survival of 22.1 months, statistically indistinguishable from the remainder of the cohort (p = 0.21). Acute esophagitis was mild, with a 3% rate of grade 3 esophagitis and no cases of grade 4 or 5.
Split-course CRT appeared effective and was delivered with a favorable toxicity profile. Poor-risk patients experienced better than expected survival. Prospective evaluation of split-course CRT must be completed before it can be considered a standard treatment option in locally advanced NSCLC.
同步放化疗（CRT）是治疗不可切除局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。在拉什大学医学中心，局部晚期 NSCLC 患者接受分割 CRT 治疗，试图最大限度地提高疗效和耐受性。我们回顾了自 1999 年以来我们在晚期 NSCLC 方面的经验。对高危患者进行了亚组分析。
所有诊断为 IIIA/IIIB 期 NSCLC 并在 1999 年 1 月至 2008 年 12 月期间接受确定性分割 CRT 治疗的患者均纳入本回顾性研究。主要终点是总生存。高危患者按照正在进行的合作组试验进行定义。
共确定了 144 例患者，35%为 IIIA 期，65%为 IIIB 期。有 52 例高危患者和 92 例中危患者。所有患者的中位生存时间为 20.4 个月，3 年总生存率为 32.1%。高危患者的中位生存时间为 22.1 个月，与其余队列无统计学差异（p = 0.21）。急性食管炎较轻，3%的患者发生 3 级食管炎，无 4 级或 5 级食管炎病例。
分割 CRT 似乎有效，且毒性特征良好。高危患者的生存情况好于预期。必须完成前瞻性评估分割 CRT 后，才能将其视为局部晚期 NSCLC 的标准治疗选择。
