Maggi G, Casadio C, Cianci R, Oliaro A, Molinatti M, Bretti S, Clerico M, Boidi-Trotti A, Rovea P
Department of Thoracic Surgery, University of Turin, Italy.
J Cardiovasc Surg (Torino). 1994 Aug;35(4):341-6.
From April 1991 to September 1993, 18 patients affected by a presumed operable IIIa (N2) non small cell lung cancer (NSCLC) with histologically confirmed bulky mediastinal metastases, received preoperative concurrent radiation therapy and continuous infusion of cisplatinum (CDDP). The radiotherapy consisted of 2 Gy given 5 days a week for a total dose of 50 Gy; CDDP was administered by means of a central catheter and a portable pump at the daily dose of 6 mg/m2 given on the same days as the radiation therapy (total dose: 150 mg/m2). Two weeks after the end of the treatment, the patients were reevaluated: 5 patients had either local or distant disease progression, the other 13 were submitted to thoracotomy: 12 received a complete resection and 1 patient underwent only a mediastinal lymphadenectomy, because pneumonectomy was impossible due to lack of respiratory function. No histological evidence of cancer cells was observed in the specimens of 6 patients (33%). Radiological response rate was 61% (11/18); resection rate was 66% (12/18) and complete resection rate was 61% (11/18). There was one postoperative death (5%). The 3 year actuarial survival rate is 63.6% for the patients who received a resection with a median survival time of 18 months. All non operated patients died within one year. Combined preoperative treatment was well tolerated. Better results were achieved in patients with squamous cell carcinoma who had a complete resection following a total tumor sterilization with radio-chemotherapy.
1991年4月至1993年9月，18例被认为可手术切除的Ⅲa期（N2）非小细胞肺癌（NSCLC）患者，经组织学证实有巨大纵隔转移，接受了术前同步放疗和顺铂（CDDP）持续输注。放疗方案为每周5天，每天2 Gy，总剂量50 Gy；CDDP通过中心静脉导管和便携式泵给药，在放疗当天给予每日剂量6 mg/m²（总剂量：150 mg/m²）。治疗结束两周后，对患者进行重新评估：5例患者出现局部或远处疾病进展，其他13例接受了开胸手术：12例实现了完全切除，1例仅进行了纵隔淋巴结清扫，因为由于呼吸功能不足无法进行肺切除术。6例患者（33%）的标本中未观察到癌细胞的组织学证据。放射学缓解率为61%（11/18）；切除率为66%（12/18），完全切除率为61%（11/18）。有1例术后死亡（5%）。接受切除的患者3年精算生存率为63.6%，中位生存时间为18个月。所有未手术的患者在一年内死亡。术前联合治疗耐受性良好。鳞状细胞癌患者在放化疗使肿瘤完全消退后进行完全切除，取得了更好的结果。
