高危早期周围型非小细胞肺癌的治疗选择:亚肺叶切除、立体定向消融放射治疗、还是射频消融?

doi:10.3969/j.issn.1006-7795.2015.04.005

摘要/Abstract

摘要： 亚肺叶切除是治疗高危早期周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的首选,而对于不能手术的患者,可以选择非手术治疗,如立体定向消融放射治疗(stereotactic ablative radiotherapy,SABR)和射频消融(radiofrequency ablation,RFA)。目前研究证实,在高危患者中,SABR和RFA的合并症发生率低和恢复快,且与亚肺叶切除等效,但是还需要前瞻性临床研究。

关键词: 高危, 非小细胞肺癌, 治疗

Abstract: Sublobar(segmental or wedge) resection is the preferred approach for high-risk patients with clinical stage I non-small cell lung cancer. Nonoperative therapies, such as stereotactic ablative radiotherapy(SABR) or radiofrequency ablation(RFA) should be reserved for surgically inoperable patients. SABR and RFA may be clinically equivalent to sublobar resection for the high-risk patients because of lower procedural morbidity and more rapid return to normal function; However, this has not yet been determined in prospective studies.

Key words: high risk, non-small cell lung cancer, treatment

中图分类号:

刘宝东. 高危早期周围型非小细胞肺癌的治疗选择:亚肺叶切除、立体定向消融放射治疗、还是射频消融?[J]. 首都医科大学学报, 2015, 36(4): 537-543.

Liu Baodong. Approaching the igh risk patients with early stage non-small cell lung cancer: Sublobar resection, stereotactic ablative radiotherapy, or radiofrequency ablation？[J]. Journal of Capital Medical University, 2015, 36(4): 537-543.

参考文献

[1] Goldstraw P, Crowley J, Chansky K, 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]. J Thorac Oncol, 2007,2(8):706-714.
[2] Donington J, Ferguson M, Mazzone P, et al. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer[J]. Chest, 2012,142(6):1620-1635.
[3] Howington J A,Blum M G,Chang A C,et al. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2013,143(5 Supp):e278S-e313S.
[4] Churchill E D, Belsey R. Segmental pneumonectomy in bronchiectasis;the lingual segment of the left upper lobe[J]. Ann Surg, 1939,109(4):481-499.
[5] Jensik R J,Faber L P,Milloy F,et al. Segmental resection for lung cancer. A fifteen-year experience[J]. J Thorac Cardiovasc Surg,1973,66(4):563-572.
[6] Hoffmann T H,Ransdell H T. Comparison of lobectomy and wedge resection for carcinoma of the lung[J]. J Thorac Cardiovasc Surg,1980,79(2):211-217.
[7] Date H,Andou A,Shimizu N. The value of limited resection for "clinical" stage I peripheral non-small cell lung cancer in poor-risk patients: comparison of limited resection and lobectomy by a computer-assisted matched study[J]. Tumori,1994,80(6):422-426.
[8] Martin-Ucar A E,Nakas A,Pilling J E,et al.A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients[J]. Eur J Cardiothoracic Surg,2005,27(4):675-679.
[9] Read R C,Yoder G,Schaeffer R C. Survival after conservative resection for T1N0M0 non-small cell cancer[J]. Ann Thorac Surg,1990,49(3):391-398.
[10] Ginsberg R J,Rubinstein L V. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group[J]. Ann Thorac Surg,1995,60(3):615-622.
[11] Okada M,Koike T,Higashiyama M,et al. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study[J]. J Thorac Cardiovasc Surg,2006,132(4):769-775.
[12] Nakamura H,Taniguchi Y,Miwa K,et al. Comparison of the surgical outcomes of thoracoscopic lobectomy, segmentectomy, and wedge resection for clinical stage I non-small cell lung cancer[J]. Thorac Cardiovasc Surg,2011,59(3):137-141.
[13] Kates M,Swanson S,Wisnivesky J P. Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer≤1 cm in size: a review of SEER data[J]. Chest,2011,139(3):491-496.
[14] Yang C F,D'Amico T A. Thoracoscopic segmentectomy for lung cancer[J]. Ann Thorac Surg,2012,94(2):668-681.
[15] Atkins B Z,Harpole D H Jr,Mangum J H,et al. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach[J]. Ann Thorac Surg,2007,84(4):1107-1112;discussion 1112-1113.
[16] Shapiro M,Weiser T S,Wisnivesky J P,et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer[J]. J Thorac Cardiovasc Surg,2009,137(6):1388-1393.
[17] Yamashita S,Chujo M,Kawano Y,et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer[J]. J Surg Res,2011,166(1):46-51.
[18] Soukiasian H J,Hong E,McKenna R J Jr.Video-assisted thoracoscopic trisegmentectomy and left upper lobectomy provide equivalent survivals for stage IA and IB lung cancer[J]. J Thorac Cardiovasc Surg,2012,144(3):S23-S26.
[19] Zhong C,Fang W,Mao T,et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer[J]. Ann Thorac Surg, 2012,94(2):362-367.
[20] Zhao X,Qian L,Luo Q,et al. Segmentectomy as a safe and equally effective surgical option under complete video-assisted thoracic surgery for patients of stage I non-small cell lung cancer[J]. J Cardiothorac Surg,2013,8:116.
[21] Ren M,Meng Q,Zhou W,et al. Comparison of short-term effect of thoracoscopic segmentectomy and thoracoscopic lobectomy for the solitary pulmonary nodule and early-stage lung cancer[J]. Onco Targets Ther,2014,7:1343-1347.
[22] Hwang Y,Kang C H,Kim H S,et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study[J]. Eur J Cardiothorac Surg,2014,pii:ezu422.
[23] Uematsu M,Shioda A,Suda A,et al. Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience[J]. Int J Radiat Oncol Biol Phys,2001,51(3):666-670.
[24] Onishi H,Araki T,Shirato H,et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study[J]. Cancer,2004,101(7):1623-1631.
[25] Onishi H,Shirato H,Nagata Y,et al. Stereotactic body radiotherapy(SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery?[J]. Int J Radiat Oncol Biol Phys,2011,81(5):1352-1358.
[26] Lagerwaard F J,Verstegen N E,Haasbeek C J,et al. Outcomes of stereotactic ablative radiotherapy in patients with potentially operable stage I non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2012,83(1):348-353.
[27] Nagata Y,Takayama K,Matsuo Y,et al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame[J]. Int J Radiat Oncol Biol Phys,2005,63(5):1427-1431.
[28] Fakiris A J,McGarry R C,Yiannoutsos C T,et al. Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four year results of a prospective phase II study[J]. Int J Radiat Oncol Biol Phys,2009,75(3):677-682.
[29] Timmerman R,Paulus R,Galvin J,et al. Stereotactic body radiation therapy for inoperable early stage lung cancer[J]. JAMA,2010,303(11):1070-1076.
[30] Onishi H,Araki T. Stereotactic body radiation therapy for stage I non-small-cell lung cancer: a historical overview of clinical studies[J]. Jpn J Clin Oncol,2013,43(4):345-350.
[31] Grills I S,Mangona V S,Welsh R,et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer[J]. J Clin Oncol,2010,28(6):928-935.
[32] Crabtree T D,Denlinger C E,Meyers B F,et al. Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer[J]. J Thorac Cardiovasc Surg,2010,140(2):377-386.
[33] Port J L,Parashar B,Osakwe N,et al. A propensity-matched analysis of wedge resection and stereotactic body radiotherapy for early stage lung cancer[J]. Ann Thorac Surg,2014,98(4):1152-1159.
[34] Chang J Y,Senon S,Paul M A,et al. Stereotactic ablative radiotherapy versus lobectomy for operabl stage Inon-small cell lung cancer:a pooled analysis of two randomised trials[J]. Lancet Oncol,2015,16(6):630-637.
[35] 周伟生,陈慕豪.肺癌射频消融治疗[J].医学影像学杂志,2006,16(2):199-201.
[36] Hiraki T,Gobara H,Iishi T,et al. Percutaneous radiofrequency ablation for clinical stage I non-small cell lung cancer: results in 20 nonsurgical candidates[J]. J Thorac Cardiovasc Surg,2007,134(5):1306-1312.
[37] Hiraki T, Gobara H, Mimura H, et al. Percutaneous radiofrequency ablation of clinical stage I non-small cell lung cancer[J]. J Thorac Cardiovasc Surg,2011,142(1):24-30.
[38] Simon C J,Dupuy D E,DiPetrillo T A,et al. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients[J]. Radiology,2007,243(1):268-275.
[39] Lanuti M,Sharma A,Digumarthy S R,et al. Radiofrequency ablation for treatment of medically inoperable stage I non-small cell lung cancer[J]. J Thorac Cardiovasc Surg,2009,137(1):160-166.
[40] Zhu J C,Yan T D,Morris D L. A systematic review of radiofrequency ablation for lung tumors[J]. Ann Surg Oncol,2008,15(6):1765-1774.
[41] Lencioni R,Crocetti L,Cioni R,et al. Response to radiofrequency ablation of pulmonary tumours:a prospective,intention-to-treat,multicentre clinical trial(the RAPTURE study)[J]. Lancet Oncol,2008,9(7):621-628.
[42] Ambrogi M C,Fanucchi O,Cioni R,et al. Long-term results of radiofrequency ablation treatment of stage I non-small cell lung cancer: a prospective intention-to-treat study[J]. J Thorac Oncol,2011,6(12):2044-2051.
[43] Kim S R,Han H J,Park S J,et al. Comparison between surgery and radiofrequency ablation for stage I non-small cell lung cancer[J]. Eur J Radiol, 2012,81(2):395-399.
[44] Ambrogi M C,Fanucchi O,Dini P,et al. Wedge resection and radiofrequency ablation for stage I non-small cell lung cancer[J]. Eur Respir J,2015,45(4):1089-1097.
[45] Zemlyak A,Moore W H,Bilfinger T V. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer[J]. J Am Coll Sur,2010,211(1):68-72.
[46] Bilal H,Mahmood S,Rajashanker B,et al. Is radiofrequency ablation more effective than stereotactic ablative radiotherapy in patients with early stage medically inoperable non-small cell lung cancer?[J]. Interact Cardiovasc Thorac Surg,2012,15(2):258-265.
[47] Bott M J,Crabtree T. Treatment of stage I lung cancer in high-risk and inoperable patients: SBRT vs. RFA vs. sublobar resection[J]. Ann Cardiothorac Surg,2014,3(2):167-169.