Slotman B J, Njo K H, Karim A B
Dept. of Radiation Oncology, Free University Hospital, Amsterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 1994 Apr 30;29(1):33-7. doi: 10.1016/0360-3016(94)90223-2.
Retrospective study of patients with Stage I nonsmall cell lung cancer (NSCLC) unable to undergo surgery or refusing surgery.
Between 1984 and 1990, 47 patients with technically operable Stage I NSCLC received hypofractionated radiotherapy. The total dose varied from 32 Gy in six fractions (two fractions/week) or 40 Gy split course in ten fractions (low-dose schedules) to 48 Gy in 12 fractions or 56 Gy in 20 fractions (high-dose schedules). The mean age of the patients was 75 years. Three patients refused surgery and 44 patients were inoperable due to their medical condition. Severe associated disease was present in 34 patients (72.3%).
The intrathoracic recurrence rate was 25.5%. In a multivariate analysis, tumor size was identified as the only significant factor predictive for intrathoracic failure (p < 0.001). Disease-specific survival was 90, 53, and 32% at 1, 3, and 5 years, respectively. In Cox's proportional hazards analysis, only tumor size was predictive for disease-specific survival. Overall survival (all causes) was 70, 33, and 15% at 1, 3, and 5 years, respectively. In Cox's proportional hazards analysis, only the presence of severe associated disease was predictive for overall survival (p < 0.01), while tumor size did not attain statistical significance (p = 0.08). There were no severe acute or late side-effects.
Radiotherapy can effectively control small nonsmall cell tumors. The reported results are comparable to those achieved with more fractionated radiation schedules. In patients of age or in poor medical condition, hypofractionated radiotherapy can be given with curative intent, with minimal burden to the patient.
对无法进行手术或拒绝手术的Ⅰ期非小细胞肺癌（NSCLC）患者进行回顾性研究。
1984年至1990年间，47例技术上可手术的Ⅰ期NSCLC患者接受了大分割放疗。总剂量从6次分割的32 Gy（每周2次分割）或10次分割的40 Gy分段疗程（低剂量方案）到12次分割的48 Gy或20次分割的56 Gy（高剂量方案）不等。患者的平均年龄为75岁。3例患者拒绝手术，44例因身体状况无法手术。34例患者（72.3%）存在严重合并症。
胸内复发率为25.5%。多因素分析中，肿瘤大小被确定为预测胸内失败的唯一显著因素（p<0.001）。1年、3年和5年的疾病特异性生存率分别为90%、53%和32%。在Cox比例风险分析中，只有肿瘤大小可预测疾病特异性生存。1年、3年和5年的总生存率（所有原因）分别为70%、33%和15%。在Cox比例风险分析中，只有严重合并症的存在可预测总生存（p<0.01），而肿瘤大小未达到统计学意义（p = 0.08）。未出现严重的急性或晚期副作用。
放疗可有效控制小的非小细胞肿瘤。报告的结果与更常规分割放疗方案所取得的结果相当。对于年龄较大或身体状况较差的患者，大分割放疗可用于根治性治疗，对患者的负担最小。
