三模态治疗上沟非小细胞肺癌：47 例连续患者的机构系列。
Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients.
机构信息
Department of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
出版信息
Curr Oncol. 2023 Apr 27;30(5):4551-4562. doi: 10.3390/curroncol30050344.
OBJECTIVES
Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution.
MATERIALS AND METHODS
The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45-66 Gy delivered in 25-33 fractions over 5-6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed.
RESULTS
From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45-66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3-4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4-94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment.
CONCLUSIONS
Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes.
目的
目前，采用同步放化疗后手术治疗胸壁上沟肿瘤（SST）是一种标准的治疗方法。然而，由于该实体的罕见性，其治疗的临床经验仍然很少。在这里，我们介绍了在单一学术机构接受同步放化疗后手术治疗的一组大连续系列患者的结果。
材料和方法
研究组包括 48 例经病理证实的 SST 患者。治疗方案包括术前 6MV 光子束放疗（45-66Gy，在 5-6.5 周内分 25-33 次给予）和同步两周期铂类化疗。放化疗完成后 5 周，行肺和胸壁切除术。
结果
2006 年至 2018 年，48 例符合方案标准的连续患者中有 47 例接受了两周期顺铂为基础的化疗和同步放疗（45-66Gy），随后进行了肺切除术。一名患者因诱导治疗期间发生脑转移而未行手术。中位随访时间为 64.7 个月。放化疗耐受性良好，无与毒性相关的死亡。21 例（44%）发生 3-4 级不良反应，其中最常见的是中性粒细胞减少（17 例；35.4%）。17 例（36.2%）发生术后并发症，90 天死亡率为 2.1%。3 年和 5 年总生存率（OS）分别为 43.6%和 33.5%，3 年和 5 年无复发生存率分别为 42.1%和 32.4%。13 例（27.7%）和 22 例（46.8%）患者有完全和主要的病理缓解，分别。完全肿瘤消退患者的 5 年 OS 为 52.7%（95%CI 29.4-94.5）。长期生存的预测因素包括年龄<70 岁、完全切除、病理分期和诱导治疗反应。
结论
放化疗后手术是一种相对安全的方法，具有令人满意的结果。
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