Sandler H M, Curran W J, Turrisi A T
Department of Radiation Oncology, Fox Chase Cancer Center, University of Pennsylvania, Philadelphia.
Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):9-13. doi: 10.1016/0360-3016(90)90127-6.
From 1970 through 1987, 77 patients with Stage I lung cancer were treated with definitive radiation therapy (RT) alone at the Fox Chase Cancer Center or the Hospital of The University of Pennsylvania. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidates for surgical resection because of premorbid medical problems or patient refusal. The median age was 72 years, although 10 patients were over 80. The histologic cell type was squamous in 44, adenocarcinoma in 15, large cell in 3, adenosquamous in 1, non-small cell in 11, and bronchioli-alveolar in 3. Tumor size was retrievable in 75 patients and 25 were less than or equal to 3 cm, 41 from 3-6 cm, and 9 greater than 6 cm. Diagnostic staging varied during the study period. Twelve patients, evaluated with a CT scan of the chest, including the liver, and a bone scan were classified as having "excellent" staging, 24 patients with conventional tomography, liver-spleen scan and a bone scan had "good" staging, and 41 patients were staged less rigorously. The RT was of megavoltage energy in all patients. The median dose was 60 Gy. The mediastinum was treated in all but eight patients who had poor pulmonary function. Survival was measured from the date of pathologic diagnosis. The actuarial 3-year survival rate of the entire group of patients is 17% with a median survival time of 20 months. Of the 61 deaths, 51 were due to disease and 10 were due to intercurrent disease without evidence of tumor recurrence. The actuarial 3-year disease-specific survival (DSS) was 22%. The 3-year disease-specific survival for patients with tumors less than 3 cm and from 3-6 cm was 30% and 17%, respectively. All nine patients with tumors greater than 6 cm were dead of disease. Local progression occurred in 33 patients, resulting in a 44%, 3-year actuarial freedom from local progression. The median time to local failure was 28 months and there were no local failures after 3 years in the 18 patients eligible for observation beyond this point. Of the patients with "excellent" staging, only 2 of 12 were dead of disease compared with 22 of 24 with "good" staging and 30 of 41 of the remainder. In this large group of Stage I non-small cell lung cancer, thorough pre-treatment staging and smaller tumor size are associated with a more favorable outcome.
1970年至1987年期间，77例I期肺癌患者在福克斯蔡斯癌症中心或宾夕法尼亚大学医院仅接受了根治性放射治疗（RT）。所有患者均经病理诊断为非小细胞肺癌，由于存在基础疾病或患者拒绝，不适合手术切除。中位年龄为72岁，其中10例患者年龄超过80岁。组织学细胞类型为鳞状细胞癌44例，腺癌15例，大细胞癌3例，腺鳞癌1例，非小细胞癌11例，细支气管肺泡癌3例。75例患者可获取肿瘤大小信息，其中25例小于或等于3 cm，41例为3 - 6 cm，9例大于6 cm。在研究期间，诊断分期有所不同。12例接受胸部CT扫描（包括肝脏）和骨扫描评估的患者被分类为“优秀”分期，24例接受传统断层扫描、肝脾扫描和骨扫描的患者为“良好”分期，41例患者的分期则不太严格。所有患者均接受兆伏级能量的放射治疗。中位剂量为60 Gy。除8例肺功能差的患者外，所有患者均接受了纵隔治疗。从病理诊断日期开始计算生存率。整个患者组的3年精算生存率为17%，中位生存时间为20个月。在61例死亡患者中，51例死于疾病，10例死于并发疾病且无肿瘤复发证据。3年疾病特异性生存率（DSS）为22%。肿瘤小于3 cm和3 - 6 cm的患者3年疾病特异性生存率分别为30%和17%。所有9例肿瘤大于6 cm的患者均死于疾病。33例患者出现局部进展，3年精算无局部进展率为44%。局部失败的中位时间为28个月，在18例有资格在此时间点之后进行观察的患者中，3年后无局部失败情况。在“优秀”分期的患者中，12例中只有2例死于疾病，而“良好”分期的24例中有22例，其余41例中有30例。在这一大组I期非小细胞肺癌患者中，全面的治疗前分期和较小的肿瘤大小与更有利的预后相关。
