术后放疗在接受新辅助化疗联合手术切除的非小细胞肺癌的应用进展

doi:10.3760/cma.j.cn113030-20200601-00288

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摘要新辅助化疗联合手术切除是非小细胞肺癌的标准治疗模式之一,但其疗后局部区域复发率较高。术后放疗(PORT)能显著降低该模式治疗后的局部区域复发率,但对改善生存的价值尚未完全明确:一部分研究认为其不能改善Ⅱ-ⅢA(N2)期患者的生存,另一部分研究则认为其可使高危患者的生存获益。目前此类患者PORT的指征包括R1、R2切除及ypN2期。PORT技术首选三维适形与调强放疗;R0切除患者放疗剂量50~54Gy可兼顾疗效与安全;靶区范围目前尚无定论,但研究多倾向于只进行受累淋巴结区域照射。大部分研究中PORT的不良反应在可接受范围之内。但目前相关研究的证据等级较低,尚需前瞻性研究来证实上述结论。

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	包永兴
	惠周光

关键词 ：癌,非小细胞肺/术后放射疗法, 癌,非小细胞肺/新辅助化学疗法, 研究进展

Abstract：Neoadjuvant chemotherapy followed by surgery (NCS) is a common therapy pattern of non-small cell lung cancer (NSCLC). However, patients treated with NCS still suffer from relatively high locoregional recurrence. Postoperative radiotherapy (PORT) plays an important role in improving locoregional control, whereas its effect on survival remains controversial. Some studies propose that PORT yields no survival benefits for stage Ⅱ-ⅢA(N2) patients treated with NCS, whereas other researches indicate that PORT can bring survival benefits for high-risk patients. The indications of PORT include R1/R2 resection and ypN2. PORT is recommended with three-dimensional conformal therapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) within the dose range of 50-54Gy (R0 resection). The target volume is inconclusive and the irradiation range of mediastinum involving with the metastatic lymph node regions is recommended in many studies.The adverse effects of PORT are acceptable in most studies.Nevertheless, the evidence level of relevant studies is relatively low. These results remain to be clarified by prospective randomized clinical trials.

Key words： Carcinoma, non-small cell lung/postoperative radiotherapy Carcinoma, non-small cell lung/neoadjuvant chemotherapy Research progress

收稿日期: 2020-06-01

基金资助:国家重点研发计划(2017YFC1311000);都临床特色应用研究与成果推广(Z171100001017114) ;中国医学科学院重点实验室:肺癌转化研究重点实验室(2018PT31035);教育部创新团队(IRT-17R10)

通讯作者: 惠周光,Email:drhuizg@163.com

引用本文:

包永兴,惠周光. 术后放疗在接受新辅助化疗联合手术切除的非小细胞肺癌的应用进展[J]. 中华放射肿瘤学杂志, 2022, 31(1): 90-96.

Bao Yongxing,Hui Zhouguang. Postoperative radiotherapy for non-small cell lung cancer treated with neoadjuvant chemotherapy followed by surgery[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 90-96.

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