Background and objective: The efficacy of complete resection of the cancer for patients with stage IIIa non-small cell lung cancer (NSCLC) is limited. Synthetic therapy is taken the lead in advocating at present. However, the value of post-operative radiotherapy is not still clear. The aim of this study is to evaluate the survival time and side effects of postoperative chemotherapy or chemoradiotherapy in the treatment of stage IIIa NSCLC.
Methods: Between December 2003 and June 2007, 52 cases that have completed followed-up data with stage IIIa of NSCLC received in the First Affiliated Hospital of Dahan Medical University. Twenty-three patients received postoperative chemoradiotherapy (group A) and 29 patients received postoperative chemotherapy combined with radiotherapy (group B). Group A adopted platinum-based combination chemotherapy for 4-6 cycles. The chemotherapeutics included gemcitabine, vinorelbine and docetaxel. Group B used chemotherapy for 2-4 cycles and then received 3-dimensional conformal radiotherapy (3D-CRT). The prescribe dose of target volume was 50 Gy. The chemotherapy was same as for group A and needed 4 cycles in all. The impact of postoperative adjuvant treatment on survival and toxicity was observed in patients with stage IIIa NSCLC and the reason of disease progression was analyzed.
Results: The median survival was 32.5 months in group A and 31.9 months in group B (P = 0.371). Progression-free survival extended about 6 months (P = 0.044). The survival rate was 87% at 1 year, 0.1% at 2 year, 33% at 3 year for group A compared with 93%, 69%, 45% for group B. The major side effects were hematological and gastrointestinal toxicities, including nausea, vomiting and neutropenia. There was no significant difference in these toxicities between the two groups (P > 0.05). Radioactive esophageal infection occurred in 17.2% of the patients. Acute and late radioactive lung infection occurred in 13.8% and 27.6% of the patients. All these toxicities were below degree 2. Distant metastases were the main reason of disease progression. There was no significant difference in the rates of local recurrence and metastases between the two groups (P > 0.05).
Conclusion: Combined modality therapy should be the main therapy of stage IIIa NSCLC. The addition of radiotherapy can effectively prolong progression-free survival and don't highly increase the toxicities.
背景与目的: Ⅲa期非小细胞肺癌（non-small cell lung caner, NSCLC）单纯根治性手术获益有限，目前倡导多学科综合治疗，但术后放疗的价值仍不清楚。本文比较分析Ⅲa期NSCLC术后化疗和术后放疗+化疗的生存期及副反应。
方法: 分析2003年12月-2007年6月大连医科大学第一附属医院收治的具有完全随访资料的Ⅲa期NSCLC患者52例。术后化疗组23例，术后放疗+化疗组29例。术后化疗组采用铂类为主的联合化疗方案，联合化疗药包括吉西他滨、长春瑞滨、多西他赛，化疗共4周期。术后放疗+化疗组采用序贯放化治疗，化疗2-4周期后加用放射治疗，放射治疗采用三维适形放疗（3D-CRT），靶区剂量50 Gy，化疗共4周期，化疗方案同单纯化疗组。观察Ⅲa期非小细胞肺癌术后辅助治疗对生存期的影响及毒副作用，分析疾病进展原因。
结果: 术后化疗组、术后放化疗组中位生存时间为32.5个月vs 31.9个月，差异无统计学意义（P=0.371）。两组中位无进展生存时间为11.0个月vs 17.0个月，差异有统计学意义（P=0.044）。两组1、2、3年生存率为87%、61%、33% vs 93%、69%、45%。不良反应主要表现在消化道和血液学方面，即恶心、呕吐及白细胞下降，两组间差异无统计学意义（P > 0.05）；放射性食管炎发生率为17.2%，急性及晚期放射性肺损伤发生率分别为13.8%和27.6%，均为Ⅱ级以下。疾病进展原因主要为远处转移，局部复发率及转移发生率两组比较差异无统计学意义（P > 0.05）。
结论: Ⅲa期NSCLC治疗要以综合治疗为主；放疗的介入延长了无进展生存时间，并未显著增加治疗的毒副作用。