Komaki R, Mountain C F, Holbert J M, Garden A S, Shallenberger R, Cox J D, Maor M H, Guinee V F, Samuels B
Department of Clinical Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):31-6. doi: 10.1016/0360-3016(90)90130-c.
Superior sulcus (Pancoast) tumors (SST) are uncommon carcinomas of the lung with distinctive failure patterns and a somewhat more favorable prognosis than other sites of lung cancer. The most effective use of surgery (S), radiation (R), and chemotherapy (C) is not resolved. Most reported series include patients treated before the era of computed tomography (CT). A retrospective study was undertaken of all previously untreated patients with SST who received definitive management at the University of Texas M.D. Anderson Cancer Center between January 1977 and December 1987. Eighty-five patients were treated: the male:female ratio was 2.7:1, and the ages ranged from 35 to 80 (median 59) years. Karnofsky performance status (KPS) was 80 or more in 70 patients (82%). Thirty patients (35%) had lost 5% or more body weight. All had histologic or cytologic confirmation of carcinoma: 25% were squamous cell, 2% small cell, 54% adenocarcinoma, and 6% were large cell carcinoma (12% were not classified). After complete evaluation, 43 were classified as clinical Stage IIIA and 42 were Stage IIIB. One Stage IIIA patient received surgery, 13 surgery + radiation therapy, 2 surgery + radiation therapy and chemotherapy, 19 radiation therapy and 8 radiation therapy + chemotherapy. Seven Stage IIIB patients received surgery + radiation therapy, 12 radiation therapy, 2 surgery + radiation therapy + chemotherapy, 17 radiation therapy + chemotherapy and 4 chemotherapy. Surgery was a component of therapy more frequently in Stage IIIA than IIIB (p less than .05) and systemic treatment chemotherapy was used significantly more often (p less than .01) in Stage IIIB. Twenty-six patients (31%) lived 2 years or more (25+ to 131+ months) after treatment. Stage IIIA patients had a 46.5% 2-year survival rate compared to 20.6% for Stage IIIB (p = .0042). The one patient treated with surgery alone lived 2 years; 23% (7/31) of patients who had radiation therapy alone and none of the 4 who had chemotherapy lived 2 years. When surgery was a component of treatment, 52% (13/25) lived 2+ years, compared with 22% (13/60) when surgery was not part of treatment. When radiation therapy was part of treatment 31% lived 2 years and when chemotherapy was used, 18% lived 2 years. Fifty-two patients (61%) had control of the local tumor: their survival was significantly greater (p less than .01) than those who had local failure.(ABSTRACT TRUNCATED AT 400 WORDS)
肺上沟（潘科斯特）瘤（SST）是一种罕见的肺癌，具有独特的衰竭模式，预后比肺癌的其他部位稍好。手术（S）、放疗（R）和化疗（C）的最有效应用尚未明确。大多数报道的系列研究纳入的患者是在计算机断层扫描（CT）时代之前接受治疗的。对1977年1月至1987年12月期间在德克萨斯大学MD安德森癌症中心接受确定性治疗的所有未经治疗的SST患者进行了一项回顾性研究。共治疗了85例患者：男女比例为2.7:1，年龄范围为35至80岁（中位年龄59岁）。70例患者（82%）的卡氏功能状态（KPS）为80或更高。30例患者（35%）体重减轻了5%或更多。所有患者均经组织学或细胞学确诊为癌症：25%为鳞状细胞癌，2%为小细胞癌，54%为腺癌，6%为大细胞癌（12%未分类）。经过全面评估，43例被分类为临床ⅢA期，42例为ⅢB期。1例ⅢA期患者接受了手术，13例接受了手术+放疗，2例接受了手术+放疗+化疗，19例接受了放疗，8例接受了放疗+化疗。7例ⅢB期患者接受了手术+放疗，12例接受了放疗，2例接受了手术+放疗+化疗，17例接受了放疗+化疗，4例接受了化疗。ⅢA期患者比ⅢB期患者更常将手术作为治疗的一部分（p<0.05），ⅢB期患者更常使用全身治疗化疗（p<0.01）。26例患者（31%）在治疗后存活了2年或更长时间（25+至131+个月）。ⅢA期患者的2年生存率为46.5%，而ⅢB期患者为20.6%（p=0.0042）。仅接受手术治疗的1例患者存活了2年；单独接受放疗的患者中有23%（7/31）存活了2年，接受化疗的4例患者均无存活2年。当手术作为治疗的一部分时，52%（13/25）存活了2年以上，而手术不是治疗一部分时为22%（13/60）。当放疗作为治疗的一部分时，31%存活了2年，使用化疗时，18%存活了2年。52例患者（61%）实现了局部肿瘤控制：他们的生存率显著高于出现局部衰竭的患者（p<0.01）。（摘要截断于400字）
