Bohndorf W, Kiricuta C, Willner J
Klinik und Poliklinik für Strahlentherapie, Universität Würzburg.
Strahlenther Onkol. 1994 Sep;170(9):507-15.
To find out the indications for treatment and selection criteria of patients who will profit from curative radiotherapy.
A literature review and own data concerning the lymphogenous metastatic pathways and incidence of involvement of loco-regional lymph nodes are used to define the biological treatment volume of a curative irradiation. A retrospective analysis of 266 patients with non-small-cell lung cancer (NSCLC) was performed. The metastatic pathway of the lymphogenous spread was analysed based on pretherapy CT scan as well as clinical examination.
Only carefully selected patients under similar selection criteria as for curative surgery are suitable to undergo a curative radiotherapy. The biological treatment volume for curative irradiation has to include the primary with a margin, the ipsilateral hilar nodes as well as the whole mediastinum including the subcarinal lymph nodes, but not the contralateral hilar and supraclavicular lymph nodes. The survival rate of patients with N3 nodal stage are 0%. A 3-step concept for curative radiotherapy until 70 Gy is proposed.
A limited number of patients with NSCLC, carefully selected as for surgery, are suitable to undergo a curative radiotherapy with 70 Gy. This will enable to demonstrate a curative value of radiotherapy.
明确可从根治性放疗中获益的患者的治疗适应证及选择标准。
通过文献回顾以及关于淋巴转移途径和局部区域淋巴结受累发生率的自身数据，来界定根治性放疗的生物靶区。对266例非小细胞肺癌（NSCLC）患者进行了回顾性分析。基于治疗前CT扫描及临床检查，分析了淋巴转移的途径。
只有在与根治性手术相似的选择标准下经过仔细挑选的患者才适合接受根治性放疗。根治性放疗的生物靶区必须包括带有一定边界的原发灶、同侧肺门淋巴结以及包括隆突下淋巴结在内的整个纵隔，但不包括对侧肺门和锁骨上淋巴结。N3分期患者的生存率为0%。提出了直至70 Gy的根治性放疗三步方案。
经过像手术患者那样仔细挑选的少数NSCLC患者适合接受70 Gy的根治性放疗。这将能够证明放疗的根治价值。
