Department of Neurosurgery, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
Cancer Control. 2014 Apr;21(2):158-67. doi: 10.1177/107327481402100209.
The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection.
A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence.
A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%.
Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
局部侵袭性肺癌的首选治疗方法是同步放化疗联合诱导化疗，然后进行手术的三联疗法。对于没有纵隔 N2 淋巴结受累且无远处转移的累及脊柱的局部晚期 T4 肺尖肿瘤患者，完全切除后进行脊柱重建是合适的。本综述探讨了局部晚期肺尖肿瘤的三联疗法与其他治疗方法或不完全切除的治疗方法相比，在总生存和并发症发生率方面是否具有优势。
使用常见的医学数据库进行了全面的文献检索。对文章的纳入和排除标准进行了前瞻性定义。对文章进行了独立审查，并对每篇文章达成了共识决定。选择的论文按证据水平进行分级。
共检索到 1001 篇摘要和 93 篇文章，其中 14 篇符合纳入标准。在本次检索中未发现 1 级研究。发现了 4 项 2 级研究和 10 项 3 级回顾性病例系列研究。这些研究报告的 5 年总生存率从 37%到 59%不等，死亡率从 0%到 6.9%不等。
有证据表明，对于累及脊柱的局部晚期肺尖肿瘤的三联疗法联合完全切除，优于其他治疗方法或不完全切除的治疗方法。
