Albain K S, Rusch V W, Crowley J J, Rice T W, Turrisi A T, Weick J K, Lonchyna V A, Presant C A, McKenna R J, Gandara D R
Loyola University Medical Center, Maywood, IL, USA.
J Clin Oncol. 1995 Aug;13(8):1880-92. doi: 10.1200/JCO.1995.13.8.1880.
To assess the feasibility of concurrent chemotherapy and irradiation (chemoRT) followed by surgery in locally advanced non-small-cell lung cancer (NSCLC) in a cooperative group setting, and to estimate response, resection rates, relapse patterns, and survival for stage subsets IIIA(N2) versus IIIB.
Biopsy proof of either positive N2 nodes (IIIAN2) or of N3 nodes or T4 primary lesions (IIIB) was required. Induction was two cycles of cisplatin and etoposide plus concurrent chest RT to 45 Gy. Resection was attempted if response or stable disease occurred. A chemoRT boost was given if either unresectable disease or positive margins or nodes was found.
The median follow-up time for 126 eligible patients [75 stage IIIA(N2) and 51 IIIB] was 2.4 years. The objective response rate to induction was 59%, and 29% were stable. Resectability was 85% for the IIIA(N2) group eligible for surgery and 80% for the IIIB group. Reversible grade 4 toxicity occurred in 13% of patients. There were 13 treatment-related deaths (10%) and 19 others (15%) died of causes not related to toxicity or tumor. Of 65 relapses, 11% were only locoregional and 61% were only distant. There were 26 brain relapses, of which 19 were the sole site or cause of death. There was no survival difference (P = .81) between stage IIIA(N2) versus stage IIIB (median survivals, 13 and 17 months; 2-year survival rates, 37% and 39%; 3-year survival rates, 27% and 24%). The strongest predictor of long-term survival after thoracotomy was absence of tumor in the mediastinal nodes at surgery (median survivals, 30 v 10 months; 3-year survival rates, 44% v 18%; P = .0005).
This trimodality approach was feasible in this Southwest Oncology Group (SWOG) study, with an encouraging 26% 3-year survival rate. An Intergroup study is currently being conducted to determine whether surgery adds more to the risk or to the benefit of chemoRT.
在协作组环境中评估同步化疗和放疗（放化疗）后手术治疗局部晚期非小细胞肺癌（NSCLC）的可行性，并估计ⅢA（N2）期与ⅢB期亚组的反应、切除率、复发模式和生存率。
需要活检证实N2淋巴结阳性（ⅢA N2）或N3淋巴结或T4原发灶（ⅢB）。诱导治疗为两个周期的顺铂和依托泊苷加胸部同步放疗至45 Gy。如果出现反应或疾病稳定，则尝试进行手术切除。如果发现疾病不可切除、切缘阳性或淋巴结阳性，则给予放化疗强化治疗。
126例符合条件的患者（75例ⅢA（N2）期和51例ⅢB期）的中位随访时间为2.4年。诱导治疗的客观缓解率为59%，29%病情稳定。适合手术的ⅢA（N2）组的可切除率为85%，ⅢB组为80%。13%的患者出现可逆性4级毒性反应。有13例治疗相关死亡（10%），另有19例（15%）死于与毒性或肿瘤无关的原因。在65例复发患者中，11%仅为局部区域复发，61%仅为远处复发。有26例脑转移，其中19例是唯一的转移部位或死亡原因。ⅢA（N2）期与ⅢB期之间无生存差异（P = 0.81）（中位生存期分别为13个月和17个月；2年生存率分别为37%和39%；3年生存率分别为27%和24%）。开胸术后长期生存的最强预测因素是手术时纵隔淋巴结无肿瘤（中位生存期分别为30个月和10个月；3年生存率分别为44%和18%；P = 0.0005）。
在西南肿瘤协作组（SWOG）的这项研究中，这种三联治疗方法是可行的，3年生存率令人鼓舞，为26%。目前正在进行一项组间研究，以确定手术对放化疗的风险或益处是否有更多影响。
