Tanı Konulmuş Tek Mediastinal Metastazı (N2) Olan Küçük Hücreli Dışı Akciğer Kanserli Hastalarda Definitif Kemo/Radyoterapi nin Cerrahi ve Sağkalıma Etkisi
Abstract
Giriş:
Platin bazlı kemoterapi ve ful doz radyoterapinin kombinasyonu, tek veya çoklu lenf nodu metastazı olan Evre III (N2) KHDAK hastaları için standart tedavi yöntemidir. Bununla birlikte, lenf nodu ve uzak metastazı olmayan hastalarda akciğer rezeksiyonu yapılabilir.
Yöntemler:
Ocak 2010 ile Aralık 2013 arasında patolojik olarak kanıtlanmış, evre IIIA / N2 küçük hücreli dışı akciğer kanserili hastalar kaydedildi. Kemoradyoterapi grubundakiler üç döngü neoadjuvan kemoterapi (AUCx2 karboplatin ve dosetaksel 85 mg / m2 [2] dosetaksel) ve 3 hafta boyunca 34 fraksiyonda 61.2 Gy ile eşzamanlı radyoterapi ve ardından cerrahi rezeksiyon yapıldı. Ayrıca definitif kemoradyoterapi alan bir grup hasta cerrahi grupla karşılaştırıldı. İki gruptaki tüm hastaların kemoradyoterapi sonrası N2 hastalığı olmadığı kanıtlandı.
Sonuçlar:
Toplam 29 hasta kaydedildi, bunlardan 6'sı definitif kemoradyoterapi, ardından cerrahi rezeksiyon ve 21'i sadece kemoradyoterapi aldı, postoperatif hiçbir hasta ölmedi, iki hastada şiddetli toksisite vardı. Medyan genel sağkalım kemoradyoterapi + cerrahi grubunda 26.66 ± 4.35 ay) ve kemoradyoterapi grubunda 21.75 ± 4.82 ay (4.0-38.6) idi (p = 0, 275).
Sonuç:
Definitif kemoradyoterapi sonrası pulmoner rezeksiyon güvenlidir ve kemoradyoterapi sonrası cerrahi rezeksiyon, histolojik olarak kanıtlanmış N2 evre IIIA küçük hücreli dışı akciğer kanserinde daha iyi sağkalım sağlayabilir.
Supporting Institution
herhangi bir kurumdan destek alınmadı
References
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The Effect of Definitive Chemo / Radiotherapy on Surgery and Survival In Patients With Non-Small Cell Lung Cancer with A Single Mediastinal Metastasis (N2) Diagnosed
Abstract
Background:
A combination of platinum-based chemotherapy and definitive radiotherapy is the standard of care for Stage III (N2) NSCLC patients who have single or multiple lymph node metastasis. However, lung resection could be performed in patients with residual disease without lymph node metastasis.
Methods:
Between January 2010 and December 2013 eligible patients had pathologically proven, stage IIIA/N2 non-small-cell lung cancer and were prospectively recorded. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (AUCx2 carboplatin and docetaxel 85 mg/m[2 ] docetaxel) and concurrent radiotherapy with 61.2 Gy in 34 fractions over 3 weeks followed by surgical resection. Also, a group of patients who had definitive chemoradiotherapy without chemoradiotherapy was compared with the surgical group. All patients in two groups were proven to have no N2 disease after chemoradiotherapy.
Results:
A total of 29 patients were enrolled, of whom 6 received chemoradiotherapy followed by surgical resection and 21 had chemoradiotherapy only.No patient died postoperatively.Two patients had severe toxicity. Median overall survival was 26.66 ± 4.35 and months) in the chemoradiotherapy + surgery group and 21.75 ± 4.82 months (4.0–38.6) in the chemoradiotherapy group (p=0, 275).
Conclusion:
Pulmonary resection after definitive chemoradiotherapy is safe and surgical resection after chemoradiotherapy may provide better survival in histologically proven N2 stage IIIA non-small cell lung cancer.
References
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- 2) Blackstock AW, Govindan R. Definitive chemoradiation for the treatment of locally advanced non small-cell lung cancer. J Clin Oncol. 2007;25(26):4146-52.
- 3) P. Goldstraw, J. Crowley, K. Chansky, D.J. Giroux, P.A. Groome, R. Rami-Porta, et al., The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours, J. Thorac. Oncol. 2 (2007) 706–714.
- 4) B.D. Daly, R.J. Cerfolio, M.J. Krasna, Role of surgery following induction therapy for stage III non-small cell lung cancer, Surg. Oncol. Clin. North Am. 20 (2011) 721–732.
- 5) N. Martini, B.J. Flehinger, The role of surgery in N2 lung cancer, Surg. Clin. North Am. 67 (1987) 1037–1049.
- 6) D.H. Johnson, L.H. Einhorn, A. Bartolucci, R. Birch, G. Omura, C.A. Perez, et al., Thoracic radiotherapy does not prolong survival in patients with locally advanced, unresectable non-small cell lung cancer, Ann. Intern. Med. 113 (1990) 33–38.
- 7) NCCN Guidelines for Non-small Cell Lung Cancer 2020-3. https://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- 8) Albain KS, Scott CB, Rusch VR. Phase III comparison of concurrent chemotherapy plus radiotherapy (CT/RT) and CT/ RT followed by surgical resection for stage IIIA (pN2) non-small cell lung cancer (NSCLC): Initial results from intergroup trial 0139 (RTOG 93-09). Proc Am Soc Clin Oncol 2003.
- 9) Pless M, Stupp R, Ris HB, Stahel RA, Weder W, Thierstein S, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomized trial. Lancet. 2015;386(9998): 1049-56.
- 10) Goldstraw P, Crowley JJ. The International Association for the Study of Lung Cancer International Staging Project on Lung Cancer. J Thorac Oncol 2007; 1: 281-6.
- 11) Wahl RL, Jacenne H, Kasamon Y, Lodge MA. From recist to percist: Evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50:122S-150S.
- 12) Bauman JE, Mulligan MS, Martins RG, Kurland BF, Eaton KD, Wood DE. Salvage lung resection after definitive radiation (>59 Gy) for non-small cell lung cancer: surgical and oncologic outcomes. Ann Thorac Surg 2008;86: 1632–8; discussion 38–9.
- 13) Kuzmik GA, Detterbeck FC, Decker RH, Boffa DJ, Wang Z, Oliva IB et al. Pulmonary resections following prior definitive chemoradiation therapy are associated with acceptable survival. Eur J Cardiothorac Surg 2013;44: e66–70.
- 14) Yang CF, Meyerhoff RR, Stephens SJ, Singhapricha T, Toomey CB, Anderson KL et al. Long-term outcomes of lobectomy for non-small cell lung cancer after definitive radiation treatment. Ann Thorac Surg 2015;99: 1914–20.
- 15) Chen F, Matsuo Y, Yoshizawa A, Sato T, Sakai H, BandoT, et al. Salvage lung resection for non-small cell lung cancer after stereotactic body radiotherapy in initially operable patients. J Thorac Oncol 2010;5:1999–2002.
- 16) Hishida T, Nagai K, Mitsudomi T, Yokoi K, Kondo H, Horinouchi H et al. Salvage surgery for advanced non-small cell lung cancer after response to gefitinib. J Thorac Cardiovasc Surg 2010;140:e69–71.
- 17) Shepherd FA, Ginsberg R, Patterson GA, Feld R, Goss PE, Pearson FG et al. Is there ever a role for salvage operations in limited small-cell lung cancer? J Thorac Cardiovasc Surg 1991;101:196–200.
- 18) Shimada Y, Suzuki K, Okada M, Nakayama H, et al. Feasibility and efficacy of salvage lung resection after definitive chemoradiation therapy for Stage III non-small-cell lung cancer. Interactive Cardiovasc Thorac Surg 2016;1-7.
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Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | April 30, 2021 |
| Submission Date | November 19, 2020 |
| Published in Issue | Year 2021 Volume: 10 Issue: 1 |
