Talton B M, Constable W C, Kersh C R
Dept. of Radiation Oncology, Holston Valley Hospital/Laguardia Cancer Center, Kingsport, TN 37660.
Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):15-21. doi: 10.1016/0360-3016(90)90128-7.
Recent reports suggest radiotherapy administered to the 5000-6000 cGy level can result in significant long-term survival in non-small cell carcinoma of the lung. This is particularly true for many cases that are technically operable but for medical or other reasons thoracotomy cannot be performed. Such patients drawn from Southern Appalachia where the principal industry is coal mining are the subject of this report. In this region coal miners pneumoconiosis (black lung) is common as well as other chronic respiratory disorders resulting in poor tolerance for surgery. Three hundred and eleven cases of non-small cell carcinoma were irradiated during the 4 years of 1980 through 1983. This group consisted of 77 patients with clinical Stage T1, T2, T3 all N0, M0 tumors, the majority of which were technically operable but upon whom no thoracotomy was performed because of medical reasons or patient refusal. All are available for 5-year study. Each of these patients was uniformly irradiated to 6000 cGy target dose in 30 fractions over 6 weeks using standard techniques. Absolute or crude survival in these 77 patients is as follows: 1 year, 57%; 2 year, 36%; 3 year, 21%; 4 year, 17%; and 5 year, 17%. Comparison with reported surgical series treated for cure show little difference in survival up to 2 years. Thereafter, the survival curves diverge with radiotherapy patients dying at a somewhat higher rate although by 4 years both survival curves slope similarly. A possible explanation for this difference is the advantage thoracotomy offers in early case selection allowing exclusion of advance cases from surgical reports whereas radiotherapy must include patients with occult local metastasis not identifiable on clinical grounds. This experience, among other reports include evidence that radiotherapy can result in long-term survival or cure with minimal morbidity in lung cancer patients in whom surgery carries excessive risk.
最近的报告表明，给予5000 - 6000厘戈瑞剂量的放射治疗可使非小细胞肺癌患者获得显著的长期生存。对于许多在技术上可手术但因医学或其他原因无法进行开胸手术的病例尤其如此。本报告的研究对象是来自阿巴拉契亚南部地区的此类患者，该地区主要产业为煤矿开采。在这个地区，煤矿工人尘肺（黑肺）以及其他慢性呼吸系统疾病很常见，导致患者对手术的耐受性较差。在1980年至1983年的4年期间，对311例非小细胞癌患者进行了放射治疗。该组包括77例临床分期为T1、T2、T3且均为N0、M0肿瘤的患者，其中大多数在技术上可手术，但由于医学原因或患者拒绝而未进行开胸手术。所有患者均可供进行5年研究。使用标准技术，对这些患者中的每一位均在6周内分30次给予6000厘戈瑞的靶剂量均匀照射。这77例患者的绝对或粗生存率如下：1年为57%；2年为36%；3年为21%；4年为17%；5年为17%。与报道的接受根治性手术治疗的系列病例相比，在2年以内的生存率差异不大。此后，生存曲线出现分歧，放射治疗患者的死亡率略高，尽管到4年时两条生存曲线的斜率相似。这种差异的一个可能解释是，开胸手术在早期病例选择方面具有优势，使得手术报告中排除了进展期病例，而放射治疗必须包括因临床原因无法识别的隐匿性局部转移患者。除其他报告外，这一经验表明，对于手术风险过高的肺癌患者，放射治疗可使患者获得长期生存或治愈，且发病率最低。
