Koryllos Aris, Ludwig Corinna, Engel-Riedel Walburga, Hammer-Helmig Michaela, Stoelben Erich
Klinik für Thoraxchirurgie, Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie Universität Witten Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland.
Thoraxonkologie, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Deutschland.
Zentralbl Chir. 2017 Sep;142(S 01):S26-S32. doi: 10.1055/s-0043-114731. Epub 2017 Sep 28.
Stage III non-small cell lung cancer (NSCLC) and its possible multimodal therapy present a challenge to the responsible oncologist, chest surgeon and radiologist. The aim of the present retrospective study was to analyse and evaluate the treatment algorithm in our hospital for patients with stage III NSCLC (intention to treat). We compared an aggressive treatment regime with primary trimodal therapy (high dose radiochemotherapy and resection), independently of "multilevel" N2 or "single level" N3 status. These results were then compared with a historical group of our patients who solely received simultaneous radiochemotherapy (bimodal therapy). Within the period of the study, 156 patients were diagnosed with stage III NSCLC and treated with trimodal therapy. The median age was 71 years. 103 patients (60%) were male, 53 (34%) female. In the group with bimodal therapy, 102 patients were evaluated. After radiological restaging and checking functional resectability, 90 patients (57.7%) in the trimodal therapy group received secondary resection, including 37 (41.1%) lobectomies/bilobectomies, 37 (41.1%) sleeve lobectomies, 13 (14.4%) pneumonectomies and 3 (3.3%) segmentectomies (for severely restricted pulmonary function). The median survival time in the trimodal therapy group was 535 days and in the bimodal group 388 days; this difference was not statistically significant (p = 0.1377). Finally the 5-year survival after actual therapy was performed ("as-treated trimodally" vs. "as-treated bimodally"). The median survival time was then 807 days for trimodal therapy and 427 days for bimodal therapy. High dose neoadjuvant radiochemotherapy followed by secondary resection is still a valuable option for selected patients with stage III NSCLC. However, this retrospective analysis failed to find a statistically significant survival advantage for the "intention-to-treat" trimodal patients.
III期非小细胞肺癌（NSCLC）及其可能的多模式治疗对负责的肿瘤学家、胸外科医生和放射科医生构成了挑战。本回顾性研究的目的是分析和评估我院对III期NSCLC患者的治疗方案（意向性治疗）。我们比较了积极治疗方案与原发性三联疗法（高剂量放化疗和手术切除），无论其为“多站式”N2或“单站式”N3状态。然后将这些结果与我院一组仅接受同步放化疗（双模式治疗）的历史患者进行比较。在研究期间，156例患者被诊断为III期NSCLC并接受了三联疗法。中位年龄为71岁。103例患者（60%）为男性，53例（34%）为女性。在双模式治疗组中，评估了102例患者。在进行放射学再分期并检查功能可切除性后，三联疗法组中的90例患者（57.7%）接受了二次手术切除，包括37例（41.1%）肺叶切除术/双肺叶切除术、37例（41.1%）袖状肺叶切除术、13例（14.4%）全肺切除术和3例（3.3%）肺段切除术（用于严重受限的肺功能）。三联疗法组的中位生存时间为535天，双模式组为388天；这种差异无统计学意义（p = 0.1377）。最后，对实际治疗后的5年生存率进行了分析（“三联疗法实际治疗”与“双模式疗法实际治疗”）。三联疗法的中位生存时间为807天，双模式疗法为427天。高剂量新辅助放化疗后进行二次切除仍然是部分III期NSCLC患者的一个有价值的选择。然而，这项回顾性分析未能发现“意向性治疗”三联疗法患者具有统计学意义的生存优势。
