术前放疗对Ⅱ期和Ⅲ期肺癌切除率及远期疗效的影响

Influence of Preoperative Radiotherapy on Resection Rate and Long-Term Efficacy for Patients with StageⅡandⅢLung Carcinomas

背景与目的:肺癌的早期发现及诊断有一定的困难,相当一部分病人在出现临床症状而就诊时属于中晚期(部分Ⅲb、Ⅳ期),已经不适合手术治疗。对于部分Ⅱ期和Ⅲ期的肺癌病人,因伴有同侧肺门或纵隔淋巴结转移,手术切除困难较大,或因心肺功能较差,而不能耐受较大范围的肺切除时(双肺叶或全肺切除),过去主张先进行术前放射治疗,以期提高手术切除率及远期疗效。本文的目的在于探讨术前放射治疗对Ⅱ期和Ⅲ期肺癌的手术切除率,及远期疗效的影响。方法:1985-1995年,62例肺癌病人经术前放射治疗并接受手术(A组),同期未行术前放射治疗而采用手术的肺癌病人共1615例(B组)。分析术前放射治疗的治疗作用,比较A、B两组间Ⅱ期和Ⅲ期肺癌病人的手术切除率、术后并发症的发生率及远期疗效。结果:A、B两组间Ⅱ期和Ⅲ期肺癌病人的手术切除率(84.2%vs84.5%,χ2=0.187,P>0.05);3、5年生存率无显著差异(χ2=9.86,P>0.05),A组Ⅱ期和Ⅲ期病人的术后并发症的发生率高于B组同期病人(12.3%vs5.8%,χ2=6.84,P<0.05)。结论:术前放射治疗并没有提高Ⅱ期和Ⅲ期肺癌的手术切除率和远期生存率。除非有助于选择肺癌能被理想切除的手术方式或减小手术切除的范围,否则,术前放射治疗应慎重考虑。

Background &Objective:It is difficult to diagnose lung carc inomas in early stage.Quite a few patients are in advanced stages(partial stageⅢb andⅣ)and unsuitable for surgical treatme nt when they come to see doctors with some clinical symptoms.For some patients with stageⅡandⅢlung carcinomas,especially associated with ipsilateral hilar and /or mediastinal lymph nodes meta stasis,it is very difficult to resect the tum ors,or the patients cant tolerate doubl e lobectomy or pneumonectomy because of cardio-pulmonary function defic iency.For these patients,preopera tive radiotherapy was chosen firstly in the past,in ord er to improve resection rate and long-term efficacy.The aim of this study was to explore the effect of resection rate and long-term efficacy of preoperative radi otherapy for stageⅡandⅢlung carcinomas.Methods:From 1985to 1995,62patients with lu ng carcinomas(group A)received preoperative radiotherap y and operation.At the same time,1615patients with lung carcinomas(group B)received operation alone.The resec tion rate,3and 5-year survival rates and the incidence of postopera tive complications for stageⅡandⅢlung carcinomas were analyzed.Results:There were no significant differences of the rese ction rate(84.2%vs 84.5%,χ 2 =0.187,P>0.05),as well as the 3and 5-year survival rates(χ 2 =9.86,P>0.05)between the two groups for stageⅡ 515andⅢlung carcinomas.The incidence of co mplications of group A for stageⅡandⅢlung carcinomas was higher than that of group B (12.3%vs 5.8%,χ 2 =6.84,P<0.05).Conclusions:Preoperative radiotherapy is helpl ess to improve the resection rate and the long-term sur vival rate of stageⅡandⅢlung carcinomas.In our opinion,it s hould not be taken into consideration unless it enables sur gical resection to be done in the pati ents with inadequate pulmonary rese rve and achieve the same surgical margin as a pneumonectomy.