Kawaguchi Koji, Yokoi Kohei, Niwa Hiroshi, Ohde Yasuhisa, Mori Shoichi, Okumura Sakae, Shiono Satoshi, Ito Hiroyuki, Yano Motoki, Shigemitsu Kikuo, Hiramatsu Yoshinori, Okami Jiro, Saito Hiroshi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Thorac Surg. 2014 Oct;98(4):1184-91. doi: 10.1016/j.athoracsur.2014.05.022. Epub 2014 Aug 7.
The chest wall is the most common neighboring structure involved by locally advanced lung cancers. However, the optimal treatment strategy for such tumors has not been established. This phase II trial was therefore conducted with the aim of evaluating whether induction chemoradiotherapy followed by surgery improves the survival of patients with T3N0 or T3N1 lung cancer involving the chest wall.
Patients with resectable T3N0 or T3N1 non-small cell lung cancer involving the chest wall were candidates for this study. Induction therapy consisted of two cycles of cisplatin and vinorelbine chemotherapy concurrent with 40 Gy of radiation. Surgical resection was performed 3 to 6 weeks after the last day of chemotherapy.
From January 2009 to November 2012, 51 eligible patients (40 stage IIB and 11 stage IIIA tumors) were entered in this study. Induction therapy was completed as planned in 49 (96%) patients, and 25 (51%) had a partial response revealed on computed tomography. Forty-eight patients underwent pulmonary resection combined with chest wall resection, and 44 (92%) underwent a complete resection. Pathologic examinations of the resected specimens revealed no viable tumor cells in 12 (25%) cases and minimal residual disease in 31 (65%) cases. Five patients experienced major postoperative complications, and 1 patient died of postoperative exacerbation of interstitial pneumonia.
The initial results of this study showed the treatment regimen to be safe and feasible with a high rate of a pathologic response for patients with lung cancer involving the chest wall in a multiinstitutional setting.
胸壁是局部晚期肺癌最常累及的邻近结构。然而，此类肿瘤的最佳治疗策略尚未确立。因此开展了这项II期试验，旨在评估诱导放化疗后行手术是否能提高T3N0或T3N1累及胸壁的肺癌患者的生存率。
可切除的T3N0或T3N1累及胸壁的非小细胞肺癌患者为本研究对象。诱导治疗包括两个周期的顺铂和长春瑞滨化疗，同时进行40 Gy的放疗。在化疗最后一天后的3至6周进行手术切除。
2009年1月至2012年11月，51例符合条件的患者（40例IIB期和11例IIIA期肿瘤）纳入本研究。49例（96%）患者按计划完成诱导治疗，25例（51%）在计算机断层扫描上显示部分缓解。48例患者接受了肺切除联合胸壁切除，44例（92%）完成了根治性切除。切除标本的病理检查显示，12例（25%）病例无存活肿瘤细胞，31例（65%）病例有微小残留病灶。5例患者出现严重术后并发症，1例患者死于术后间质性肺炎加重。
本研究的初步结果表明，该治疗方案对于多机构环境下累及胸壁的肺癌患者是安全可行的，且病理缓解率高。
