Brundage M D, Bezjak A, Dixon P, Grimard L, Larochelle M, Warde P, Warr D
Department of Radiation Oncology, Kingston Regional Cancer Centre, Ontario.
Can J Oncol. 1996 Feb;6 Suppl 1:25-32.
Non-small cell lung cancer is the most common cause of cancer death in both males and females. Despite this high incidence and mortality, comparatively little research has addressed the palliative treatment of thoracic symptoms. Until recently, information regarding the indications and effectiveness of radiation in this setting was obtained from retrospective reviews of single institutional experiences. More recently, three major randomized trials from the UK Medical Research Council (1991, 1992, 1994) have addressed the use of external beam radiation in randomized comparisons of different dose and fractionation strategies for patients with non-small cell lung cancer and symptoms due to intra-thoracic tumor. These studies show that shorter fractionation schemes provide equivalent palliation and essentially equivalent survival in the patient groups studied. Moreover, they provide estimates of the probability of successful palliation of common symptoms, and estimates of the toxicity of each regimen. A panel of oncologists with expertise in radiation oncology, medical oncology and epidemiology discussed the above trial results and a literature review. The panel concluded that radiation was indicated in the palliation of hemoptysis, chest pain, dysphagia, and dyspnea, and that the results of the MRC studies provided reasonable estimations of the efficacy and toxicity of radiation in this setting. These studies show that symptoms are more often than not improved with palliative radiotherapy (symptom improvement rates ranged from about 50 to 85%) and that palliation lasted for a substantial portion of the patients' remaining survival. The panel could not reach uniform consensus on the appropriate fractionation for radiation given with palliative intent. The panel agreed that favourable patients with stage IIIB NSCLC should be offered combined modality therapy with the intent of prolonging survival, and that patient preferences regarding the risks and benefits of this therapy should be considered. Further study was recommended, namely, a randomized trial evaluating five fractions of radiation vs a single fraction, using patient-based evaluation of palliation. The panel also recommended phase II development of a combined chemotherapy and low-dose radiation protocol appropriate for future study.
非小细胞肺癌是男性和女性癌症死亡的最常见原因。尽管发病率和死亡率很高，但针对胸部症状的姑息治疗的研究相对较少。直到最近，关于这种情况下放疗的适应症和有效性的信息还是从对单一机构经验的回顾性研究中获得的。最近，英国医学研究委员会的三项主要随机试验（1991年、1992年、1994年）探讨了对于非小细胞肺癌且有胸内肿瘤引起症状的患者，在不同剂量和分割方案的随机比较中使用外照射放疗的情况。这些研究表明，在研究的患者群体中，较短的分割方案能提供同等的姑息治疗效果且生存期基本相同。此外，它们还给出了常见症状成功姑息治疗的概率估计以及每种治疗方案的毒性估计。一组在放射肿瘤学、医学肿瘤学和流行病学方面有专业知识的肿瘤学家讨论了上述试验结果并进行了文献综述。该小组得出结论，放疗适用于咯血、胸痛、吞咽困难和呼吸困难的姑息治疗，并且医学研究委员会的研究结果为这种情况下放疗的疗效和毒性提供了合理的估计。这些研究表明，姑息性放疗通常能改善症状（症状改善率约为50%至85%），并且姑息治疗持续了患者剩余生存期的很大一部分时间。对于姑息性放疗的合适分割方案，该小组未能达成一致共识。该小组一致认为，对于ⅢB期非小细胞肺癌的合适患者应提供旨在延长生存期的综合治疗方案，并且应考虑患者对该治疗风险和益处的偏好。建议进行进一步研究，即一项随机试验，使用基于患者的姑息治疗评估方法，比较五分割放疗与单次分割放疗。该小组还建议对适合未来研究的联合化疗和低剂量放疗方案进行Ⅱ期开发。
