Sauer R, Andreas P
Strahlentherapeutische Universitätsklinik, Universität Erlangen Nürnberg.
Helv Chir Acta. 1990 Jan;56(5):749-62.
The treatment results obtained in patients with both small and non small cell lung cancer have remained stagnant for years. Therefore, in order to select patients who will have a profit from radiotherapy the indication has to take into account prognostic factors such as tumor stage, extent of resection, patient's age, lymph node status, weight loss and the patient's performance status. Non small cell lung cancer: Postoperative radiotherapy seems to benefit only in patients with hilar or mediastinal lymph node involvement, where a five-year survival rate of up to 30% of cases can be achieved. Postoperative irradiation should not be applied following curative resection and negative lymph node status (R0 N0). In inoperable cases conventional fractionated radiotherapy may definitively have a favourable effect on the patient's survival time, even when the treatment was originally intended to be merely palliative. Only those patients will live five years, who received more than 50 Gy to the hilar and mediastinal nodes and at least 60 Gy to the primary lesion. The volume to be irradiated must include the primary tumor, the ipsilateral and contralateral hilum, the mediastinum, and both supraclavicular regions. If a Pancoast tumor is present, radiotherapy alone obtains a similar result as preoperative irradiation followed by resection. Small cell lung cancer: Radiation treatment of the primary tumor region and the lymph drainage area increases the remission rate by roughly 20% compared with chemotherapy alone, considerably reduces the incidence of local recurrences and exerts a beneficial effect on the survival of the patients. Recently, this has been confirmed by prospectively randomised protocols. Prophylactic brain irradiation has been found to decrease the risk of cerebral metastases to 4-6% in patients affected by limited disease and complete tumor remission under chemotherapy, and to improve the quality of life without, however, showing the benefit on survival time. Future efforts in radiotherapy should be aimed not only at increasing dose intensities but also at developing less toxic treatment modalities to the benefit of the quality of life.
多年来，小细胞肺癌和非小细胞肺癌患者的治疗效果一直停滞不前。因此，为了筛选出能从放疗中获益的患者，放疗指征必须考虑预后因素，如肿瘤分期、切除范围、患者年龄、淋巴结状态、体重减轻情况以及患者的体能状态。非小细胞肺癌：术后放疗似乎仅对肺门或纵隔淋巴结受累的患者有益，这类患者的五年生存率可达30%。根治性切除且淋巴结状态为阴性（R0 N0）的患者不应进行术后放疗。在无法手术的病例中，即使最初治疗目的仅为姑息性，常规分割放疗对患者的生存时间可能确实有有利影响。只有那些肺门和纵隔淋巴结接受超过50 Gy照射且原发灶至少接受60 Gy照射的患者才能存活五年。照射体积必须包括原发肿瘤、同侧和对侧肺门、纵隔以及双侧锁骨上区域。如果存在肺上沟瘤，单纯放疗与术前放疗后再行切除的效果相似。小细胞肺癌：与单纯化疗相比，对原发肿瘤区域和淋巴引流区域进行放射治疗可使缓解率提高约20%，显著降低局部复发率，并对患者生存产生有益影响。最近，前瞻性随机试验方案证实了这一点。已发现预防性脑照射可将化疗后疾病局限且肿瘤完全缓解的患者脑转移风险降低至4% - 6%，并改善生活质量，但未显示对生存时间有益处。未来放疗方面的努力不仅应旨在提高剂量强度，还应致力于开发毒性较小的治疗方式，以提高生活质量。
