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目的探讨不能切除的ⅢA(N2)期非小细胞肺癌(NSCLC)的治疗方法。方法1999年1月至2002年12月,76例不可切除ⅢA(N2)期NSCLC患者接受诺维苯(NVB,25mg/m2,第1,5天)加卡铂(300mg/m2,第1天)2个周期的化疗,第二周期化疗后3周重新评估能否手术切除。对化疗效果达到部分有效(PR)或完全有效(CR)、估计能完全切除的64例患者行剖胸探查术;对化疗后评价为稳定(SD)和进展(PD)的12例患者行放疗。64例手术患者中,完全切除(肺叶或全肺切除加纵隔淋巴结清扫术,至少达到R3水平)56例,术后继续给予诺维苯加卡铂化疗2个周期;不完全切除8例,另加局部放疗。结果76例不可切除的ⅢA(N2)期NSCLC经诱导化疗后手术或放疗,中位生存期为18.6个月,1,2,3年生存率分别为64.2%、39.4%和25.6%。其中完全切除患者的中位生存期为28.2个月,1,2,3年生存率分别为70.4%、52.5%和38.6%。结论对不可切除的局部晚期NSCLC,如诱导化疗后可以手术,应首选外科治疗。
Objective To investigate the treatment of unresectable ⅢA (N2) non-small cell lung cancer (NSCLC). METHODS: From January 1999 to December 2002, 76 patients with unresectable stage IIA (N2) NSCLC received either nocitronine (NVB, 25 mg / m2, day 1,5) plus carboplatin (300 mg / m2 on day 1 ) 2 cycles of chemotherapy, 2 weeks after the second cycle of chemotherapy to re-evaluate the possibility of surgical resection. Thoracotomy was performed on 64 patients who had partial or complete response to chemotherapy (CR), and 12 patients who were evaluated as stable (SD) and progression (PD) after chemotherapy were given radiotherapy . Sixty-four patients underwent complete resection (lobectomy or pneumonectomy plus mediastinal lymphadenectomy, at least R3 level) in 56 cases, and continued to receive Novibenbacarb platinum chemotherapy for 2 cycles after surgery. Incomplete resection was performed in 8 cases, Plus local radiotherapy. Results 76 patients with unresectable stage Ⅲ A (N2) NSCLC underwent surgery or radiotherapy after induction chemotherapy. The median survival time was 18.6 months. The 1, 2, 3 year survival rates were 64.2%, 39.4% and 25.6%, respectively. The median survival was 28.2 months in patients who underwent complete resection, with a 1-year, 2-year, 3-year survival of 70.4%, 52.5%, and 38.6%, respectively. Conclusion For unresectable, locally advanced NSCLC, surgical treatment should be the first choice if surgery can be performed after induction of chemotherapy.