Mayer R, Smolle-Juettner F M, Szolar D, Stuecklschweiger G F, Quehenberger F, Friehs G, Hackl A
Department of Radiotherapy, University Medical School of Graz, Austria.
Chest. 1997 Oct;112(4):954-9. doi: 10.1378/chest.112.4.954.
To evaluate the value of adjuvant postoperative external-beam radiation (EBR) in patients with radically resected non-small cell lung cancer (NSCLC) pT1-3 pN0-2 compared to patients with resected NSCLC without adjuvant EBR.
In 155 patients (121 male, 34 female; mean age, 59 years) 105 lobectomies, 12 bilobectomies, and 38 pneumonectomies with radical lymph node dissection of the contralateral [corrected] side were performed. Postoperative staging was done according to the TNM system and was as follows: pT1 (n=38), pT2 (n=89), pT3 (n=28); pN0 (n=39), pN1 (n=67) and pN2 (n=49). Histopathologic study revealed 68 squamous cell carcinomas, 53 adenocarcinomas, 21 large cell carcinomas, 6 adenosquamous cell carcinomas, and 7 bronchioloalveolar cell carcinomas. All patients were randomly assigned into two treatment groups: 72 patients with no further treatment (control group), and 83 patients (EBR group) with adjuvant postoperative EBR of the bronchial stump and mediastinum (50 to 56 Gy, 8 or 23 MV photons, 2 Gy/d, 5 d/wk) beginning 4 to 6 weeks after surgery.
The overall 5-year survival rate (median observation time, 43 months) of all patients was 24.1% (EBR group, 29.7%; control group, 20.4%; p>0.05, not significant). The relative risk of the EBR group was 0.85 with a two-sided confidence interval of 0.66 to 1.09. The overall 5-year recurrence-free survival was 20.6% (EBR, 27.1%; control group, 15.6%; p=0.07). The relative risk of the EBR group was 0.80 with a confidence interval of 0.63 to 1.01. The rate of local recurrences at the bronchial stump and/or mediastinum was significantly smaller in the EBR group (n=5) than in the control group (n=17) (p<0.01). Multivariate analysis (chi2 test) demonstrated an independent influence of postoperative EBR on the incidence of local recurrences. The incidence of distant metastases was slightly but not significantly higher in patients without EBR (38 patients) compared to those who had EBR (32 patients).
High-dose postoperative EBR to the mediastinum significantly reduces the risk of local recurrence at the bronchial stump and/or mediastinum. Age, sex, histologic subtype, tumor size, surgical approach, or extent of lymph node involvement had no prognostic value--only postoperative EBR had an independent influence on the risk of local recurrence. The effect of postoperative EBR was on the verge of significance with respect to recurrence-free survival and showed the same tendency in overall survival, however with an attenuated relative risk.
评估接受根治性切除的非小细胞肺癌（NSCLC）pT1 - 3 pN0 - 2患者术后辅助外照射放疗（EBR）与未接受辅助EBR的切除NSCLC患者相比的价值。
对155例患者（121例男性，34例女性；平均年龄59岁）进行了105例肺叶切除术、12例双肺叶切除术和38例全肺切除术，并对患侧[校正后]进行了根治性淋巴结清扫。术后分期根据TNM系统进行，结果如下：pT1（n = 38），pT2（n = 89），pT3（n = 28）；pN0（n = 39），pN1（n = 67）和pN2（n = 49）。组织病理学研究显示有68例鳞状细胞癌患者、53例腺癌患者、21例大细胞癌患者、6例腺鳞癌患者和7例细支气管肺泡癌患者。所有患者随机分为两个治疗组：72例患者不接受进一步治疗（对照组），83例患者（EBR组）在术后4至6周开始接受支气管残端和纵隔的辅助术后EBR（50至56 Gy，8或23 MV光子，2 Gy/天，5天/周）。
所有患者的总体5年生存率（中位观察时间43个月）为24.1%（EBR组为29.7%；对照组为20.4%；p>0.05，无显著性差异）。EBR组的相对风险为0.85，双侧置信区间为0.66至1.09。总体5年无复发生存率为20.6%（EBR组为27.1%；对照组为15.6%；p = 0.07）。EBR组的相对风险为0.80，置信区间为0.63至1.01。EBR组支气管残端和/或纵隔的局部复发率（n = 5）显著低于对照组（n = 17）（p<0.01）。多因素分析（卡方检验）显示术后EBR对局部复发发生率有独立影响。与接受EBR的患者（32例）相比，未接受EBR的患者（38例）远处转移发生率略高，但无显著性差异。
对纵隔进行高剂量术后EBR可显著降低支气管残端和/或纵隔的局部复发风险。年龄、性别、组织学亚型、肿瘤大小、手术方式或淋巴结受累程度均无预后价值——只有术后EBR对局部复发风险有独立影响。术后EBR对无复发生存率的影响接近显著水平，在总生存率方面也显示出相同趋势，但相对风险有所降低。
