Dosoretz D E, Galmarini D, Rubenstein J H, Katin M J, Blitzer P H, Salenius S A, Dosani R A, Rashid M, Mestas G, Hannan S E
Radiation Therapy Regional Center, Fort Myers, FL 33908.
Int J Radiat Oncol Biol Phys. 1993 Oct 20;27(3):507-16. doi: 10.1016/0360-3016(93)90373-4.
For patients who are medically unable to tolerate a surgical resection for technically resectable non-small-cell lung carcinoma, radiation therapy is an acceptable alternative. We report on the effect of achieving local control of the primary tumor on survival end-points, and analyze factors that may influence local control.
We reviewed the records of 152 patients with medically inoperable non-small-cell lung carcinoma treated at our institutions. All patients had technically resectable lesions and no evidence of metastatic disease. Treatment was delivered using megavoltage irradiation to doses ranging from 45 to 75 Gy.
For patients with tumors 3 cm or less, locally controlling the tumor significantly improved survival (p = .0371). Patients with T1 tumors had a higher probability of survival and disease-free-survival than patients with larger tumors if the primary tumor was locally controlled, but this survival advantage disappeared if the tumor was not controlled. Overall, patients with smaller tumors had a lower incidence of distant spread, but this association was maintained only when the primary tumor was controlled (36 month risk of 10%, 23%, and 57% for tumors < 3 cm, 3-4.9 cm, 5 cm or greater, respectively, p = .0027). For patients whose tumors were not controlled, there was no significant difference in the risk of distant dissemination by tumor size. Higher radiation doses influenced local control and metastatic spread. We observed no influence of the initial field size in the risk of local control and in the probability of survival.
Radical radiation therapy is an effective treatment for small (T1 or < 3 cm) tumors when treated to doses of 65 Gy or more, and should be offered as an alternative to surgery in elderly or infirm patients. New therapeutic strategies to improve the local control rate should be considered for larger tumors, through the use of hyperfractionated treatment, endobronchial "boost" irradiation, and sensitizing chemotherapy agents.
对于因医学原因无法耐受手术切除的可技术切除的非小细胞肺癌患者，放射治疗是一种可接受的替代方案。我们报告了实现原发肿瘤局部控制对生存终点的影响，并分析了可能影响局部控制的因素。
我们回顾了在我们机构接受治疗的152例因医学原因无法手术的非小细胞肺癌患者的记录。所有患者均有可技术切除的病变且无转移疾病证据。使用兆伏级放疗，剂量范围为45至75 Gy。
对于肿瘤直径3 cm或更小的患者，局部控制肿瘤显著提高了生存率（p = 0.0371）。如果原发肿瘤得到局部控制，T1肿瘤患者比肿瘤较大的患者有更高的生存率和无病生存率，但如果肿瘤未得到控制，这种生存优势就会消失。总体而言，肿瘤较小的患者远处转移发生率较低，但只有在原发肿瘤得到控制时这种关联才成立（肿瘤<3 cm、3 - 4.9 cm、5 cm或更大的患者36个月远处转移风险分别为10%、23%和57%，p = 0.0027）。对于肿瘤未得到控制的患者，按肿瘤大小远处转移风险无显著差异。较高的放射剂量影响局部控制和转移扩散。我们观察到初始照射野大小对局部控制风险和生存概率无影响。
根治性放射治疗对于直径小（T1或<3 cm）的肿瘤，当给予65 Gy或更高剂量时是一种有效的治疗方法，应作为老年或体弱患者手术的替代方案。对于较大肿瘤，应考虑通过使用超分割治疗、支气管内“增强”照射和增敏化疗药物等新的治疗策略来提高局部控制率。
