术前放疗对Ⅱ期和Ⅲ期肺癌切除率及远期疗效的影响

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。

Influence of preoperative radiotherapy on resection rate and long-term efficacy for patients with stage II and III lung carcinomas

BACKGROUND & OBJECTIVE: It is difficult to diagnose lung carcinomas in early stage. Quite a few patients are in advanced stages(partial stage IIIb and IV) and unsuitable for surgical treatment when they come to see doctors with some clinical symptoms. For some patients with stage II and III lung carcinomas, especially associated with ipsilateral hilar and/or mediastinal lymph nodes metastasis, it is very difficult to resect the tumors, or the patients can't tolerate double lobectomy or pneumonectomy because of cardio-pulmonary function deficiency. For these patients, preoperative radiotherapy was chosen firstly in the past, in order 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 radiotherapy for stage II and III lung carcinomas. METHODS: From 1985 to 1995, 62 patients with lung carcinomas (group A) received preoperative radiotherapy and operation. At the same time, 1615 patients with lung carcinomas (group B) received operation alone. The resection rate, 3 and 5-year survival rates and the incidence of postoperative complications for stage II and III lung carcinomas were analyzed. RESULTS: There were no significant differences of the resection rate(84.2% vs 84.5%, chi 2 = 0.187, P > 0.05), as well as the 3 and 5-year survival rates(chi 2 = 9.86, P > 0.05) between the two groups for stage II and III lung carcinomas. The incidence of complications of group A for stage II and III lung carcinomas was higher than that of group B(12.3% vs 5.8%, chi 2 = 6.84, P < 0.05). CONCLUSIONS: Preoperative radiotherapy is helpless to improve the resection rate and the long-term survival rate of stage II and III lung carcinomas. In our opinion, it should not be taken into consideration unless it enables surgical resection to be done in the patients with inadequate pulmonary reserve and achieve the same surgical margin as a pneumonectomy.