不可切除ⅢA(N2)期非小细胞肺癌的术前化疗

Preoperative induction chemotherapy for unresectable stage Ⅲ A non-small-cell lung cancer

目的探讨不能切除的ⅢA(N2)期非小细胞肺癌(NSCLC)的治疗方法。方法1999年1月至2002年12月,76例不可切除ⅢA(N2)期NSCLC患者接受诺维苯(NVB,25mg/m2,第1,5天)加卡铂(300mg/m2,第1天)2个周期的化疗,第二周期化疗后3周重新评估能否手术切除。对化疗效果达到部分有效(PR)或完全有效(CR)、估计能完全切除的64例患者行剖胸探查术;对化疗后评价为稳定(SD)和进展(PD)的12例患者行放疗。64例手术患者中,完全切除(肺叶或全肺切除加纵隔淋巴结清扫术,至少达到R3水平)56例,术后继续给予诺维苯加卡铂化疗2个周期;不完全切除8例,另加局部放疗。结果76例不可切除的ⅢA(N2)期NSCLC经诱导化疗后手术或放疗,中位生存期为18.6个月,1,2,3年生存率分别为64.2%、39.4%和25.6%。其中完全切除患者的中位生存期为28.2个月,1,2,3年生存率分别为70.4%、52.5%和38.6%。结论对不可切除的局部晚期NSCLC,如诱导化疗后可以手术,应首选外科治疗。

Objective To evaluate the potential reconsideration of curative operative treatment for patients with unresectable stage ⅢA （N2） non-small-cell lung cancer （NSCLC）. Methods From Jan. 1999 to Dec. 2002, 76 patients with unresectable stage ⅢA（N2） NSCLC were entered in this study. They had all been proved by chest CT, chest film and fiberobronchoscopy. Twenty-one （27. 6% ） patients were examined by mediastinoscopy. All the patients received two cycles of chemotherapy with NVB （25 mg/m^2, D1 ,D5） and carboplatin （300 mg/m^2,D1）. All the patients were staged again three weeks after induction chemotherapy, Sixty-four patients who achieved partial response （PR） or complete response （CR） were allowed to undergo surgery. Twelve patients who did not responde to chemotherapy received radiotherapy instead. Of the 64 surgically treated patients, 56 （84.7%） had a complete resection and then received 2 cycles of chemotherapy using the same regime, 8 patients had an incomplete resection and then received radiotherapy for the residual tumor. Results The median survival for these 76 patients with unresectable stage ⅢA（N2） NSCLC treated by either surgery or radiation after induction chemotherapy was 18.6 months with 1-, 2-, 3-year survival rate of 64.2%, 39.4% and 25.6%, respectively. The median survival for the 56 patients with a complete resection was 28.2 months with 1-, 2-, 3-year survival rate of 70.4%, 52.5% and 38.6%, respectively. Conclusion Preoperative induction chemotherapy with NVB plus carboplatin should be seriously considered for the patients with unresectable stage ⅢA （ N2 ） NSCLC, It is suggested that, whenever possible, surgery should be taken as the first choice for the patients who show down-staged benetfits that complete resection can be attempted,