ⅢA-N_(2)期非小细胞肺癌术后放疗个体化策略研究进展

Advances on individualized strategies of postoperative radiotherapy for ⅢA-N_(2) non-small cell lung cancer

目的分析ⅢA-N_(2)期非小细胞肺癌(NSCLC)术后放疗(PORT)的个体化策略与影响因素,并探讨N_(2)期NSCLC患者PORT未来发展方向。方法应用PubMed及CNKI期刊全文数据库检索系统,以“ⅢA-N_(2)期NSCLC、PORT和ⅢA-N_(2)期非小细胞肺癌及术后放疗”为关键词,检索2021-07-31前相关文献。共获得英文文献390篇,中文文献24篇。纳入标准:(1)PORT对不同临床特征ⅢA-N_(2)期NSCLC患者生存研究;(2)ⅢA-N_(2)期NSCLC PORT最佳时机研究;(3)ⅢA-N_(2)期NSCLC PORT靶区与放射剂量研究;(4)术后质子放疗研究。排除标准:(1)存在研究设计缺陷或统计学方法错误;(2)相同研究的以往版本;(3)研究数据不完整。最后纳入分析35篇文献。结果多淋巴结受累、肿瘤体积大、鳞癌男性患者可能从PORT中获益更多;术后切缘阴性患者采用序贯放化疗并优先放疗具有潜在获益可能;合理的靶区应根据术后复发模式进行勾画;标准剂量相较于高剂量生存获益更多。结论结合目前ⅢA-N_(2)期NSCLC PORT应用现状,有必要根据不同临床特征筛选PORT获益患者,并通过精确PORT时机、改良放疗技术等实现个体化精准放疗。

Objective To analyze the individualized strategies of postoperative radiotherapy(PORT)for stageⅢA-N_(2) non-small cell lung cancer(NSCLC)and to explore the future development of PORT in these patients.Methods Through PubMed and CNKI databases,relevant studies before July 2021 were searched with the keywords"ⅢA-N_(2) non-small cell lung cancer"and"postoperative radiotherapy".Inclusion criteria:(1)survival studies of stageⅢA-N_(2) NSCLC patients with different clinical characteristics;(2)studies about the best timing of PORT for stageⅢA-N_(2) NSCLC;(3)studies about radiation dose and target area;(4)studies about postoperative proton beam therapy.Exclusion criteria:(1)defective research design or statistical methods;(2)previous versions of the same study;(3)incomplete or unclear results.Based on the inclusion criteria and exclusion criteria,35 articles were finally included.Results Male patients with multiple lymph nodes,large tumor volume,and squamous cell carcinoma may obtain more survival ben efits from PORT.Sequential radiotherapy and the n chemotherapy may pote ntially benefit patients with postoperative negative margin.The targeting area should be based on the recurrence patter ns.The standard dose is better than the higher dose.Conclusion It is necessary to screen patients who will benefit more from PORT and achieve precisely individualized therapy through time regulation and technology improvement.