Mizobuchi Teruaki, Yamamoto Naoyoshi, Nakajima Mio, Baba Masayuki, Miyoshi Kentaro, Nakayama Haruhiko, Watanabe Syun-Ichi, Katoh Ryoichi, Kohno Tadasu, Kamiyoshihara Mitsuhiro, Nishio Wataru, Kamada Tadashi, Fujisawa Takehiko, Yoshino Ichiro
Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Pneumothorax Research Center and Thoracic Surgery Division, Nissan Tamagawa Hospital, Tokyo, Japan
Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan.
Eur J Cardiothorac Surg. 2016 May;49(5):1503-9. doi: 10.1093/ejcts/ezv348. Epub 2015 Oct 14.
Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT.
From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed.
There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%.
The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.
碳离子放疗（CIRT）有望成为早期非小细胞肺癌（NSCLC）手术的替代方案，即使在可手术的患者中也被用作次优选择，尽管CIRT后有时会出现局部复发。本研究的目的是调查CIRT后接受挽救性切除的局部复发患者的人口统计学数据、围手术期过程和治疗结果。
1994年11月至2012年2月，日本国立放射科学研究所对599例患者的602个c-T1/T2/T3N0M0 NSCLC病灶进行了CIRT。共有95例（16%）患者被诊断为局部复发，其中12例接受了挽救性手术。对病历进行了回顾性分析。
男性7例，女性5例（平均年龄63±7.4岁）。初次诊断为NSCLC时的临床分期如下：4例IA期、7例IB期和1例IIB期。所有患者均适合手术，但拒绝手术而接受了CIRT。CIRT后的中位无进展生存期为20个月（范围7.1 - 77个月），挽救性手术在CIRT后中位24个月（范围9 - 78个月）进行。所有手术均成功完成，术中未出现任何与CIRT相关的明显粘连，无死亡或Clavien-Dindo 3 - 4级术后并发症。然而，病理分期分布如下：4例IA期、3例IB期、2例IIB期、2例IIIA期和1例IV期，其中包括6例相对于CIRT前临床分期的分期上升。挽救性手术后总体生存的Kaplan-Meier估计显示，3年生存率为82%。
CIRT的剂量强度避开了肺门和脏层胸膜，没有患者在放射野外出现粘连，因此CIRT后局部复发的挽救性手术是安全可行的。
