同期放化疗后全肺切除治疗Ⅲ期非小细胞肺癌临床报道

Pneumonectomy for Stage Ⅲ Non-small-cell Lung Cancer after Preoperative Concurrent Chemotherapy and Radiation

目的:探讨同期放化疗后行全肺切除的Ⅲ期非小细胞肺癌患者的临床效果。方法:回顾性分析1998年5月至2008年6月我院同期放化疗后行全肺切除的37例Ⅲ期非小细胞肺癌患者的临床资料。37例患者在术前接受了同期放化疗后再行全肺切除术,其中17例行右全肺切除(包括2例肺上沟瘤)。所有患者术前均接受同期放化疗,放疗平均总剂量60.1 Gy。结果:所有患者均接受了全肺切除以达到根治切除(R0)的目的,16例(43.2%)患者达到了病理完全缓解。无手术死亡,术后平均住院天数9.1天。术后90天死亡率为2.7%(n=1)。术后共有13例(35.1%)患者出现多处转移。包括脑转移7例,骨转移5例,肝转移2例,肾上腺转移2例,肺转移2例,颈部淋巴结转移1例和小肠转移1例。5年生存率为32%。结论:同期放化疗后行全肺切除术在临床上值得进一步研究。

Objective： To study the clinical outcomes of patients undergoing pneumonectomy after preoperative concurrent chemoradiotherapy for stage Ⅲ non-small cell lung cancer. Methods ： Clinical records of 37 patients with stage Ⅲ non-small cell lung cancer were reviewed retrospectively. They underwent pneumonectomy at our institution from May 1998 to June 2008 after preoperative concurrent chemoradiotherapy. There were 17 right pneumonectomies, of which 2 were for pancoast tumors. All patients received concurrent preoperative chemoradiotherapy. Mean total radiation dose was 60. 1 Gy. Results： All patients went on to have complete （R0） resection by pneumonectomy. Pathologic complete response was found in 16 patients （43.2%）. All patients were discharged alive from the hospital after pneumonectomy. Mean hospital length of stay was 9. 1 days. Ninety-day mortality after surgery was 2.7% （ n = 1 ）. Metastases had been found in 13 patients （ 35.1% ） , including brain metastases （ n = 7 ）, bone metastases （ n = 5 ）, liver metastases （ n = 2）, adrenal metastases （ n = 2） , lung metastases （ n = 2）, cervical lymphnode metastases （ n = 1 ） and small bowel metastases（n = 1）. Estimated overall survival rate was 32% at 5 years. Conclusion： Pneumonectonay can be performed feasibly after preoperative concurrent chemoradiotherapy.