不可手术的Ⅲ期非小细胞肺癌(non-small-cell lung cancer,NSCLC)是一组异质性较强且预后较差的疾病。我国约有约有30%的NSCLC患者在初诊时即处于局部晚期。近期,GEMSTONE-301研究显示,程序性死亡受体配体-1(programmed death ligand-1,...不可手术的Ⅲ期非小细胞肺癌(non-small-cell lung cancer,NSCLC)是一组异质性较强且预后较差的疾病。我国约有约有30%的NSCLC患者在初诊时即处于局部晚期。近期,GEMSTONE-301研究显示,程序性死亡受体配体-1(programmed death ligand-1,PD-L1)单抗舒格利单抗作为巩固治疗可以改善同步或序贯放化疗后未发生疾病进展的Ⅲ期NSCLC患者的无进展生存期(progression-free survival,PFS)。该研究的结果由吴一龙教授在2021年欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)大会上口头报道,并于近期刊登于《柳叶刀-肿瘤学》。本文对该项研究数据作一评述。展开更多
体部立体定向放疗(stereotactic body radiation therapy,SBRT)是指应用单次或少数多次给予靶区高剂量照射的治疗方式。和常规放疗相比,该技术具有分割剂量大、精度高等特点。对于因高龄或合并严重心肺等内科疾病不能手术或不愿接受手...体部立体定向放疗(stereotactic body radiation therapy,SBRT)是指应用单次或少数多次给予靶区高剂量照射的治疗方式。和常规放疗相比,该技术具有分割剂量大、精度高等特点。对于因高龄或合并严重心肺等内科疾病不能手术或不愿接受手术的早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者,SBRT已被确立为标准治疗。对于可手术病灶,SBRT能达到与手术相似的局部控制率。本研究将对SBRT用于早期可手术NSCLC患者的研究进展作一综述。展开更多
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 m...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.展开更多
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 NSC...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.展开更多
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 inp...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.展开更多
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 Internati...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）,展开更多
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 ...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.展开更多
Objective： To study the efficiency, safety and feasibility of preoperative bronchial artery infusion （BAI） chemotherapy on operation in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC...Objective： To study the efficiency, safety and feasibility of preoperative bronchial artery infusion （BAI） chemotherapy on operation in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： 92 cases with locally advanced NSCLC patients were randomly divided into two groups： （1） BAI chemotherapy group： 39 cases were received BAI chemotherapy for 2 courses and followed surgery; （2） surgery alone group： 51 cases were treated by operation alone. The complete resection rate and preoperative complications were compared between these two groups. Results： In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity. In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group （72.5%, P 〈 0.05）. No significant differences of blood loss, operative complications and mortality were observed between these two groups. Conclusion： BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.展开更多
文摘不可手术的Ⅲ期非小细胞肺癌(non-small-cell lung cancer,NSCLC)是一组异质性较强且预后较差的疾病。我国约有约有30%的NSCLC患者在初诊时即处于局部晚期。近期,GEMSTONE-301研究显示,程序性死亡受体配体-1(programmed death ligand-1,PD-L1)单抗舒格利单抗作为巩固治疗可以改善同步或序贯放化疗后未发生疾病进展的Ⅲ期NSCLC患者的无进展生存期(progression-free survival,PFS)。该研究的结果由吴一龙教授在2021年欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)大会上口头报道,并于近期刊登于《柳叶刀-肿瘤学》。本文对该项研究数据作一评述。
文摘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.
文摘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.
文摘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.
文摘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）,
文摘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.
基金a grant from the Foundation of Science and Technology of Dalian (No. 20039907)
文摘Objective： To study the efficiency, safety and feasibility of preoperative bronchial artery infusion （BAI） chemotherapy on operation in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： 92 cases with locally advanced NSCLC patients were randomly divided into two groups： （1） BAI chemotherapy group： 39 cases were received BAI chemotherapy for 2 courses and followed surgery; （2） surgery alone group： 51 cases were treated by operation alone. The complete resection rate and preoperative complications were compared between these two groups. Results： In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity. In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group （72.5%, P 〈 0.05）. No significant differences of blood loss, operative complications and mortality were observed between these two groups. Conclusion： BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.
