不同年龄段非小细胞肺癌的外科临床特点及预后

背景与目的 随着社会工业化的不断发展和社会人口老龄化,肺癌的发病年龄也出现了年轻化和老龄化的趋势,因此对不同年龄肺癌患者的治疗方式也应有所不同。本研究结合临床资料对非小细胞肺癌手术后不同年龄段患者的临床特点及预后进行评价及分析。方法 回顾分析自1996年1月至2003年1月我科手术治疗1380例非小细胞肺癌患者资料,按年龄分组,第一组（青年组）（年龄≤40岁）,第二组（中年组）（年龄在41-69岁）,第三组（老年组）（年龄≥70岁）,对各组的临床特点及预后进行分析。结果 全组平均年龄（58.16±0.26）岁,其中青年组为35.76±0.57（范围12-40）,中年组为58.00±0.22（范围41-69）,老年组为72.30±0.21（范围70-80）。女性在青年组与老年组中所占比例有明显差异（P=0.024）。老年组患者伴有其他系统疾病的比例明显高于其他两组（P=0.000）。鳞癌为主要的组织细胞类型,三组所占的比例为41.79%（28/67）、54.12%（644/1190）和58.54%（72/123）,无统计学差异（P=0.080）,但腺癌在青年组的比例则高于其他两组,分别为43.28%（29/67）、29.50%（351/1190）和26.82%（33/123）（P=0.036）。肺叶和全肺切除是主要的手术方式,分别占各组的58.21%、65.29%、78.86%（P=0.004）和34.33%、26.22%、12.20%（P=0.001）。术后病理分期Ⅲ期肺癌在各组所占比例分别为43.28%（29/67）、38.82%（462/1190）和26.02%（32/123）,青年组高于其他组（P=0.015）。各组接受术后化疗的比例分别为55.22%（37/67）,47.48%（565/1190）和29.27%（36/123）（P=0.000）。全组5年生存率为38.96%,青年组29.99%,中年组39.61%,老年组37.99%（P=0.494）。结论 青年非小细胞肺癌的特点主要为女性多见,肺腺癌所占比例较大,且分期较晚,接受辅助化疗的比例大。而老年肺癌则肺鳞癌所占比例大,伴有其他系统疾病多见,术后出现并发症的机会大。但三组预后无明显差异。

术前不同肺功能肺癌患者围术期心肺并发症发生率比较

目的比较术前不同肺功能肺癌患者围术期心肺并发症发生率现况。方法连续选择近期接受手术治疗的105例原发性肺癌患者,观察他们围术期发生并发症情况,并按术前肺功能分组比较。结果 105例接受肺癌手术患者术前低肺功能状态36例(34.29%,%FEV1≤50%,低肺功能组),术前非低肺功能患者69例(对照组)。低肺功能组围术期发生肺内感染、肺不张、低氧血症、呼吸衰竭心律失常及心肺并发症发生频次均明显多于对照组(P<0.05～0.01)。结论低肺功能肺癌手术患者围术期发生心肺并发症较多。

Tolerance of Lung Cancer Patients with Moderate Pulmonary Hypofunction to Open-Chest Operation

Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction （study group） and 62 patients with normal pulmonary function （control group） were reviewed. Statistical t test and χ^2 test were set to examine the data, and logistic regression was performed to find the associated factors. Results： In patients with moderate pulmonary hypofunction, hypoxemia （41.9%）, arrhythmia and cardiac dysfunction （25.8%）, and pulmonary inflammation （25.8%） were common postoperative complications, and respiratory failure and cardiac failure （9.2%） severe complications. In-hospital mortality rate was 3.2%. In the control group, the incidence of the above 4 postoperative complications was 16.1%, 8.1%, 9.6% and 3.2% accordingly, and no case died in hospital. Regression analysis showed that age and resection range were associated with the occurrence of the complications. Conclusion： Common postoperative complications （hypoxemia） in patients with moderate pulmonary hypofunction are remarkably higher than those in control group, but severe complications and in-hospital mortality rate are not significantly high. Patients with older age and larger resection range undergo higher complication rate.

Role of surgical intervention in managing gastrointestinal metastases from lung cancer

AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.

Clinical outcomes of lung metastasectomy in patients with colorectal cancer

AIM： To investigate prognostic factors of survival fol- lowing curative, non-palliative surgical removal of lung metastases secondary to colorectal cancer （CRC）.

Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

Objective： To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods： From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period： group A （1999-2003） and group B （1989-1998）. The difference in the survival rate between groups A and B was compared. Results： The morbidity and mortality in group A was decreased significantly in comparison to group B （11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively）. However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion： Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3^rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.

A study of pulmonary embolism after abdominal surgery in patients undergoing prophylaxis

AIM： To determine risk factors for pulmonary embolism and estimate effects and benefits of prophylaxis. METHODS： We included 78 patients who died subsequently to a pulmonary embolism after major abdominal surgery from 1985 to 2003. A first, retrospective analysis involved 41 patients who underwent elective surgery between 1985 and 1990 without receiving any prophylaxis. In the prospectively evaluated subgroup, 37 patients undergoing major surgery between 1991 and 2003 were enrolled： all of them had received a prophylaxis consisting in lowmolecular weight heparin, given subcutaneously at a dose of 2850 IU AXa/0.3 mL （body weight 〈 50 kg） or 5700 IU AXa/0.6 mL （body weight ≥ 50 kg）. RESULTS： A higher incidence of thromboembolism （43.9% and 46.34% in the two groups, respectively） was found in older patients （〉 60 years）. The incidence of pulmonary embolism after major abdominal surgery in patients who had received the prophylaxis was significantly lower compared to the subjects with the same condition who had not received any prophylaxis （P 〈 0.001, OR = 2.825; 95% CI, 1.811-4.408）. Furthermore, the incidence of pulmonary embolism after colorectal cancer surgery was significantly higher compared to incidence of pulmonary embolism after other abdominal surgical procedures. Finally, the incidence of pulmonary embolism after colorectal cancer surgery among the patients who had received the prophylaxis （11/4316, 0.26%） was significantly lower compared to subjects undergoing a surgical procedure for the same indication but without prophylaxis （10/1562, 0.64%） （P 〈 0.05, OR = 2.522; 95% Ct, 1.069-5.949）. CONCLUSION： Prophylaxis with low molecular weight heparin is highly recommended during the preoperative period in patients with diagnosis of colorectal cancer due to high risk of pulmonary embolism after elective surgery.

ADENOSQUAMOUS LUNG CARCINOMA:CLINICAL CHARACTERISTICS,SURGICAL TREAMENT AND PROGNOSIS

Objective.The effectiveness of surgical resection of adenosquamous carcinoma of the lung remains poorly defined because of the histology’s relatively low frequency, the failure in most published series to separate adenosquamous carcinoma from the other variants of non-small cell lung carcinoma.To define the effectiveness of surgical treatment of adenosquamous carcinoma,we have retrospectively reviewed our hospital experience over a 12-year period. Methods.Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated,except one patient,in the PUMCH from Jan.1985 to Aug.1997.This series constitutes the 19% of a total of 1 245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results.The adenosquanous carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n=20).The overall 5-year survival was 23%.Those with stage Ⅰ tumors survival was only 18%(n=13), stage Ⅱ 5%. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months. Conclusion.Our results suggest that adenosquamous carcinoma of lung was a virulent tumor,which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46%) and its prognosis was worse than that of both squamous cell carcinoma and adenocarcinoma.

Prognostic significance of combined fibrinogen concentration and neutrophil-to-lymphocyte ratio in patients with resectable non-small cell lung cancer

Objective:Cancer-associated inflammation and coagulation cascades play vital roles in cancer progression and survival.In this study,we investigated the significance of the combination of preoperative fibrinogen and the neutrophil-to-lymphocyte ratio(NLR)in predicting the survival of patients with non-small cell lung cancer(NSCLC).Methods:We retrospectively enrolled 589 patients with NSCLC who underwent surgery.The univariate and multivariate Cox survival analyses were used to evaluate the prognostic indicators,including the combination of fibrinogen and NLR(F-NLR).The cut-off values for fibrinogen,NLR,and clinical laboratory variables were defined by the receiver operating characteristic(ROC)curve analysis.According to the ROC curve,the recommended cut-off values for fibrinogen and the NLR were 3.48 g/L and 2.30,respectively.Patients with both a high NLR(≥2.30)and hyperfibrinogenemia(≥3.48 g/L)were given a score of 2,whereas those with one or neither were scored as 1 or 0,respectively.Results:Our results showed that F-NLR was an independent prognostic indicator for disease-free survival(DFS)[hazard ratio(HR),1.466;95%confidence interval(CI),1.243–1.730;P<0.001]and overall survival(OS)(HR,1.512;95%CI,1.283–1.783;P<0.001).The five-year OS rates were 66.1%,53.5%,and 33.3%for the F-NLR=0,F-NLR=1,and F-NLR=2,respectively(P<0.001).Correspondingly,their five-year DFS rates were 62.2%,50.3%,and 30.4%,respectively(P<0.001).In the subgroup analyses of the pathological stages,the F-NLR level was significantly correlated with DFS and OS in stage I and IIIA cancers.Conclusions:Preoperative F-NLR score can be used as a valuable prognostic marker for patients with resectable early-stage NSCLC.

The anesthesia analysis of the conversion video-assisted thoracic surgery to thoracotomy in pulmonary carcinoma

Objective： The aim of this study was to anesthesia analyse the factors of conversing video-assisted thoracic surgery to thoracectomy in pulmonary carcinoma. Methods： Double-lumen tube bronchial catheter intubation and interstitial positive pressure ventilation （IPPV） were used in all patients with video-assisted thoracic surgery after fast-speed venous induced anesthesia. IPPV, positive expiratory pressure （PEEP） and continuous positive airway pressure （CPAP） in collapse lobes of lung were used in one lung ventilation, and ventilation parameters were adjusted. Results： Two hundred and fifity- two patients double-lumen bronchial tube intubation used by fiberscope was located very well. The level of oxygen saturation of blood （Sp02）, end.tidal carbon dioxide pressure （PETCO2） could be maintained normal. 5 cases were forced to converse video-assisted thoracic surgery to thoracotomy because of 2 cases pulmonary adhesion, 2 cases severe pulmonary dysfunction and 1 case abnormal anatomy respectively. Conclusion： Long one lung ventilation such as pulmonary adhesion, severe pulmonary dysfunction and abnormal anatomy should be considered to be relative contraindication.

A Study of the Number and Metastatic Status of Lymph Nodes Ressected During Non-Small Cell Lung Cancer Surgery

OBJECTIVE To analyze the number and the metastatic status of lymph nodes resected during NSCLC surgery, and to determine the relationship of the lymph node status to the prognosis. METHODS Clinical data from 1,575 inpatient NSCLC cases were retrospectively reviewed, and the number and the different metastatic status of the LNs resected analyzed. The Kaplan-Meier method was used for survival analysis. RESULTS Stage NO patients with 7 to 12 LNs resected during surgery had a significant increase in survival （P=0.001, 0.021）,compared to patients with less than 6 LNs or more than 12 LNs. Stage N1 or N2 patients with more than 12 LNs resected had a significant increase in survival（P=0.000 ,0.003）,compared with cases who had less than 6 LNs or 7 to 12 LNs resected.The 5-year survival rate of Stage NO patients was superior to Stage N1 and N2 patients （P =0.000,0.000）,and the 5-year survival rates of Stage N0 and skip N2 patients were superior to the continue N2 patients. Patients with a single station of LNs metastasis had a significant increase in survival （P=0.000）,compared with those with multiple stations of LNs metastasis. Patients with 1 to 2 metastatic LNs had a significant increase in survival （P=0.000）,compared with patients having more than 2 metastatic LNs.The metastatic LN ratio（percentage of metastatic lymph nodes resected） was divided into four subgroups： 〈25%, 25%～50%, 51%～75%, 〉 75%.The 5-year survival rate gradually decreased with an increase in the metastatic ratio. CONCLUSION For patients with NSCLC the number of LNs resected during surgery should be 7 to 12; the range and number of LN metastasis and the metastatic LN ratio significantly affect the prognosis of patients with NSCLC.

The surgical prognosis of pIIIA/N2 non-small-cell lung cancers

Objective: The aim of the study was to identify prognostic factors in non-small-cell lung cancer (NSCLC) with N2 nodal involvement.Methods: A retrospective analysis of disease free survival and 5-year survival for NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy were performed.Between January 1998 and May 2004,133 patients were enrolled.Several factors such as age,sex,skip metastasis,number of N2 lymph node stations,type of resection,histology,adjuvant therapy etc.,were recorded and analyzed.SPSS 16.0 software was used.Results: Overall 5-year survival for 133 patients was 32.33%,5-year survival for single N2 station and multiple N2 stations sub-groups were 39.62% and 27.50% respectively,and 5-year survival for cN0–1 and cN2 sub-groups were 37.78% and 20.93% respectively.COX regression analysis revealed that number of N2 station (P = 0.013,OR: 0.490,95% CI: 0.427–0.781) and cN status (P = 0.009,OR: 0.607,95% CI: 0.372–0.992) were two favorable prognostic factors of survival.Conclusion: Number of N2 station and cN status were two favorable prognostic factors of survival.In restrict enrolled circumstances,after combined therapy made up of surgery and postoperative adjuvant therapy have been performed,satisfied survival could be achieved.

Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery

Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each:endobronchial blocker tube group(group 1) and double-lumen endobronchial tube group(group 2).After anesthesia was induced,in group 1,single lumen tube was intubated at first,and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary,injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily;while in group 2,the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation.Blood samples were collected before anesthesia induction,double lumen ventilation,at the one-lung ventilation of 5 min,30 min,60 min,120 min and 180 min,SBP,DBP,HR,SpO2,partial pressure of end tidal carbon dioxide(PetCO2),pH,PaO2,PaCO2,PaO2/FiO2 were recorded.Results:Forty cases' intubations were all successful.There were no differences in SBP,DBP,HR,SpO2,PetCO2,pH,PaCO2 between two groups in different points(P > 0.05).Paw in group 1 was lower than group 2,PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min,30 min,60 min,120 min and 180 min.Conclusion:The endobronchial blocker tube can meet the request of video-assisted thoracic surgery,with the special advantages of simple insertion,lower airway and better oxygenation.Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery.

EFFECTS OF COMPOUND ACUPUNCTURE AND MEDICINE ANESTHESIA ON TNF AND INF-Γ CONTENTS IN THE PATIENT OF PNEUMONECTOMY

Objective To explore effects of acupuncture on senJm tumor necrosis factor （TNF） and ,γ-inter- feron （INF-γ） contents in the operative patient of lung cancer. Methods In the first stage, electroacupuncture （EA） stimulation was given to 25 cases of lung cancer before operation, once daily for 3 consecutive days, with continuous EA stimulation during operation; EA was given once each day from the 5^th-7^th days after operation. In the second stage, EA was added from the 8^th- 10^th days after operation in 30 cases, once daily. Serum TNF and INF-γ contents were compared before and after operation. Results Serum TNF content on the 8th day after operation in the first stage study was lower （P〈0.05） and on the 12th day after operation in the second stage study was higher （P〈0.05） in the compound anesthesia group than that in the general anesthesia group; serum INF-γ contents in the compound anesthesia group on the 8^th day after operation in the first stage and on the 12^th day after operation in the second stage were significantly higher than those in the general anesthesia group （P〈0.01, P〈0.05）. Conclusion Acupuncture can regulate serum TNF and INF-γ contents in the patient of operation of lung cancer, with dual-directional regulation on immunologic function.

Perioperative chemotherapy of stage Ⅲ N2 non-small cell lung cancer

Patients with stage Ⅲ N2 non-small cell lung cancer （NSCLC） are more than one third of all NSCLC patients. The 5-year survival rate of them is approximately 15%. From therapeutic views, stage ⅢA N2 of 97 International Lung Cancer Staging System is an obvious hetero-combination, which includes mediastinal lymph node metastasis based on microscope after postoperative examination and N2 of single station or N2 of multiple stations based on computerized tomographic scanning and N2 of mediastinal lymph node mixed together. The different status of stage N2 lead to different prognosis. Andre et al reported the results of continuous surgery in 702 patients with NSCLC, which showed that N2 of single station based on microscope, 5-year survival rate was 34% （244 cases）, N2 of multiple stations based on microscope, 5-year survival rate was 11% （788 cases）, N2 of single station based on radiograph, 5-year survival rate was 8% （118 cases）,

Application of Blocking Unilateral Main Pulmonary Artery in Pulmonary Lobectomy of Lung Cancer

OBJECTIVE To explore the application of blocking the unilateralmain pulmonary artery (MPA) in pulmonary lobectomy (PL) forpatients with stage Ⅱ and Ⅲ lung cancer, and to retrospectivelyanalyze the methods of surgery for blocking the unilateral mainpulmonary artery, perioperative indications, intraoperativeconcerns and postoperative cardio-pulmonary complications.METHODS During a period from January 2006 to January 2008,intra-pericardial, or extra-pericardial separation and blockade ofthe left or right MPA followed by completion of various PLs wereconducted for 30 lung cancer patients in stage-Ⅱ to Ⅲ with ill-defined anatomic structure of the pulmonary hilum and difficultpulmonary angiodiastasis.RESULTS In the 30 patients, 5 were diagnosed as stage-Ⅱb, 11stage-Ⅲa, and 14 stage-Ⅲb. During the surgery, giant tumors atthe superior pulmonary lobe, with a diameter of over 10 cm, wereseen in 13 cases, in which tumor invasion in the extra-pericardiacpulmonary artery was found in 5 cases. Hilar lymphadenectasiswith severe tumor adhesion to pulmonary blood vessel couldbe seen in 20 cases and partial tumorous invasion in thepericardium in 7. In most of the cases, adhesions existed aroundthe tumor, aorta, superior vena, and azygous vein. Invasion ofthe laryngeal and vagus nerves on the left side was found in 3cases. Of the 30 patients, simple PL was conducted in 12, andsleeve lobectomy combined with a pulmonary arterioplasty in18 cases. With a blockade of unilateral MPA, no intraoperativehemorrhea of pulmonary blood vessels occurred during surgery,when there was a clear surgical field of vision. Both PL andlymphadenectomy were smoothly completed in the 30 patients.The healthy pulmonary lobes with normal function were keptand total pneumonectomy was avoided. The time of blocking thepulmonary artery ranged from 10 to 30 min, and intraoperativeblood loss was from 200 to 300 ml. Postoperative complicatedacute pulmonary edema occurred in 5 patients and tachycardia in7 cases. Nevertheless, all patients recovered and left the hospitalafter treatment. No severe cardiopulmonary complications werefound in all patients of the group.CONCLUSION Blocking the unilateral MPA is effective todecrease the risk of intraoperative hemorrhea in the PL. It canshorten the time of surgery, improve the excision rate of lungcancer, and cut down on the rate of total pneumonectomy.

The applied value of modified POSSUM score in evaluating lung cancer surgery’s risk

Objective: The aim of this study was to explore the modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system and the relationship between predicted data and actual data of complication and surgical mortality of lung cancer radical surgery made by such score system. Methods: Retrospective analysis on the 86 cases of the clinical materials of patients with primary lung cancer radical surgery for thoracic surgery of line lung cancer in the 81st Hospital of PLA from October 2010 to October 2011 and using the POSSUM scoring system to predict the cases of postoperative complication and death toll, then making a comparison with the actual cases. Results: The POSSUM scoring system predicting 29 cases of postoperative complications, but 32 cases of practical complications, the difference between them has no statistical significance (P﹥0.05), 8 cases of predicted postoperative deaths, 2 cases of practical deaths, by comparison, there was statistical significance (P﹤0.05). Conclusion: The modified POSSUM scoring system can be used to predict the postoperative complication of lung surgery patients, but sometimes overestimates the postoperative death cases.

Therapy for non-small-cell lung cancer patients with brain metastasis

Brain metastasis is a major cause of poor prognosis and high mortality for non-small cell lung cancer patients. The prognosis of non-small-cell lung cancer(NSCLC) patients with brain metastasis is generally poor and more effective treatment is required to improve their prognosis. Whole-brain radiotherapy, surgery, stereotactic radiosurgery, chemotherapy and targeted therapy are the main treatment for brain metastasis. This review focuses on the five therapeutic strategy and in particular, on targeted therapy.

Role of radiation therapy in the management of stage Ⅲ non-small cell lung cancers: current status and controversies

The treatment of stage Ⅲ non-small cell lung cancer(NSCLC) consisting of the heterogeneous stage subsets remains a challenge. Overall, it has been gradually recognized that radiation therapy(RT) plays a crucial role in the management of stage Ⅲ NSCLC. One superior sulcus tumors are the subset for which the trimodality treatments are clearly preferred. One subset of stage Ⅲ NSCLC has a minimal disease burden with microscopic p N2 disease or with discrete p N2 involvement identified preoperatively, thus technically could undergo a surgical resection. For the incidentally found p N2 disease after complete surgery(ⅢA-1, ⅢA-2), the value of postoperative radiotherapy(PORT) has been recognized by a reassessment based on new data. However, doubt persists regarding how to define the clinical target volume for PORT. For the discrete p N2 involvement identified preoperatively(a selected part of ⅢA-3), induction chemoradiation therapy(CRT) before surgery may yield a survival advantage, although the phase Ⅲ randomized trials in this issue are not conclusive. The other major subset of stage Ⅲ NSCLC is the infiltrative stage Ⅲ NSCLC with N2 or N3 nodal disease(ⅢA-3, ⅢA-4, and ⅢB), for which concurrent CRT is considered as the current standard of care. The potential role of radiation dose escalation/acceleration has been proposed; however, the optimal dose fractionation remains an important unresolved question. Additionally, the role of prophylactic cranial irradiation for stage Ⅲ patients with high risk of brain metastasis is worth of further assessment. Moreover, how to integrate molecular targeted therapy with RT, as well as whether they had a role in stage Ⅲ diseases, are other controversies actively under study in ongoing trials. This review specifically describes the updated role of RT in multimodal approach to treat stage Ⅲ NSCLC and the controversies regarding these results in various situations.

Assessing no-surgical treatment response in bronchogenic carcinoma with contrast material-enhanced computed tomography

Objective:The aim of the study was to evaluate the efficacy of contrast material-enhanced computed tomography(CT) in assessing no-surgical treatment response in bronchogenic carcinoma.Methods:The 67 patients with bronchogenic carcinoma after no-surgical treatment underwent two-phase contrast material-enhanced computed tomography.Two spiral CT scans were obtained at 25 and 90 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 mL/s by using an autoinjector.Precontrast and postcontrast attenuation values on every scan were recorded and peak height was calculated.Enhancement pattern was evaluated on the image obtained at 25 and 90 s after injection of contrast medium.Results:Precontrast attenuation value,postcontrast attenuation values at 25 and 90 s were(41.26 ± 7.77) Hu,(56.45 ± 10.48) Hu,(70.82 ± 11.99) Hu,respectively.No statistically significant difference in precontrast attenuation was found between our results in this study and the results in our old study(mean precontrast attenuation 40.70 Hu) which was obtained in cases without any therapy(t = 0.593,P = 0.555﹥0.05).Peak height of bronchogenic carcinoma after no-surgical treatment [(29.40 ± 10.73) Hu] were significantly lower than that of bronchogenic carcinoma without any therapy obtained in our old study(mean peak height 35.79 Hu)(t =-4.874,P = 0.001 < 0.05).The 39 among 67 cases appeared homogeneous enhancement at 90 s.At 25 s,there were 26 cases with inhomogeneous enhancement,9 cases with homogeneous enhancement,2 cases with central enhancement,and 2 cases with peripheral enhancement among the 39 cases.Conclusion:Peak heights can reflect the blood supply of bronchogenic carcinoma and might be an index for evaluation of no-surgical treatment response in bronchogenic carcinoma.