Ⅲa期非小细胞肺癌术后辅助治疗的临床应用

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 Dalian 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.