Komaki R, Derus S B, Perez-Tamayo C, Byhardt R W, Hartz A, Cox J D
Cancer. 1987 May 1;59(9):1649-53. doi: 10.1002/1097-0142(19870501)59:9<1649::aid-cncr2820590921>3.0.co;2-1.
During a 20-year period, from 1963 to 1983, 68 patients were treated for carcinoma of the lung presenting in the superior sulcus. Their ages ranged from 41 to 79 years (median, 56 years). Thirty-six patients had squamous cell carcinoma, 13 had adenocarcinoma, 14 had large cell carcinoma, two had small cell carcinoma, and three had clinical diagnosis only. All tumors were considered to be inoperable or unresectable and were treated with external irradiation alone. The 3-year disease-free survival was 25%. Brain metastasis developed in 23 patients (34%); the brain was the first site of metastasis in 16 patients (24%), five of whom eventually developed other sites of metastasis. The cumulative probability of brain metastasis was 53% at 3 years. Brain metastases were seen in ten patients (28%) with squamous cell carcinoma, five patients (38%) with adenocarcinoma, seven patients (50%) with large cell carcinoma, and one patient without a histocytologic diagnosis. The proportion of patients younger than 60 years (19/41, 46%) who developed brain metastasis was significantly greater than that for patients 60 years or older (4/27, 15%) (P less than or equal to 0.01). Nine of 11 patients with metastasis only to the brain died as a consequence of the intracranial disease 1 to 13 months (median, 6 months) after the diagnosis of brain metastases. The other two patients received therapeutic irradiation to the entire brain and survived longer than 5 days after the whole-brain irradiation: one died at 62 months of intercurrent disease, and the other is alive and well 129 months after diagnosis. The high probability of brain metastasis from superior sulcus tumors, regardless of histopathologic type and the frequency with which the brain is the only site of clinical failure, suggest that systematic prophylactic cranial irradiation could reduce the morbidity and perhaps even contribute favorably to the survival of these patients.
在1963年至1983年的20年期间，68例肺上沟癌患者接受了治疗。他们的年龄在41岁至79岁之间（中位数为56岁）。36例为鳞状细胞癌，13例为腺癌，14例为大细胞癌，2例为小细胞癌，3例仅有临床诊断。所有肿瘤均被认为无法手术切除或不可切除，仅接受了外照射治疗。3年无病生存率为25%。23例患者（34%）发生了脑转移；脑是16例患者（24%）的首个转移部位，其中5例最终还出现了其他部位的转移。3年时脑转移的累积概率为53%。10例鳞状细胞癌患者（28%）、5例腺癌患者（38%）、7例大细胞癌患者（50%）以及1例无组织学诊断的患者出现了脑转移。年龄小于60岁的患者中发生脑转移的比例（19/41，46%）显著高于60岁及以上的患者（4/27，15%）（P≤0.01）。11例仅发生脑转移的患者中有9例在脑转移诊断后1至13个月（中位数为6个月）因颅内疾病死亡。另外2例患者接受了全脑治疗性照射，在全脑照射后存活超过5天：1例在62个月时死于并发疾病，另1例在诊断后129个月仍然健在。无论组织病理学类型如何，肺上沟肿瘤发生脑转移的概率都很高，而且脑是临床失败的唯一部位的频率也很高，这表明系统性预防性颅脑照射可能会降低这些患者的发病率，甚至可能对其生存产生积极影响。
