Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable).

摘要: BACKGROUND In general, surgery is believed to offer the best prospects for cure early stage non-small cell lung cancer (NSCLC). spite of intention consider all patients with I-II disease surgery, there are those who, although technically operable, either refuse or considered inoperable because insufficient respiratory reserve, cardiovascular general frailty. This group may therefore be "medically inoperable". Some physicians refer these radical radiotherapy whilst others believe that has little and adopt a watch policy, referring palliative only when they become symptomatic. Although evidence from randomised trials support use I/II NSCLC, it perception most clinical oncologists (radiotherapists) should receive radical, as opposed palliative, treatment (COIN 1999). OBJECTIVES To determine effectiveness morbidity medically NSCLC. SEARCH STRATEGY Randomised were sought by electronic searching Cochrane Clinical Trials Register both non-randomised Medline Excerpta Medica (Embase). Further studies identified references cited in papers already searching. SELECTION CRITERIA Studies any age NSCLC receiving at dose greater than 40Gy 20 fractions over four weeks its radiobiological equivalent. DATA COLLECTION AND ANALYSIS Two thirty-five identified. One nine did not meet selection criteria included review. MAIN RESULTS trial comparing two schedules, two-year survival was superior following continuous hyperfractionated accelerated (CHART; 37%) compared 60Gy 30 six (24%). There 26 retrospective including an estimated 2003 patients, which overall results varied between 33-72% years, 17-55% three years 0-42% five years. The proportion deaths due 11-43%. Cancer-specific 54-93% 22-56% 13-39% Complete response rates 33-61% local failure 6-70%. Distant metastases developed approximately 25% patients. Better seen smaller tumours higher doses though reasons prescribing clearly stated. Worse outcome prior weight loss poor performance status. Assessment treatment-related effects on quality life symptom control inconclusive lack prospective evaluation paucity data. REVIEWER'S CONCLUSIONS no policy immediate given develop symptoms. absence such trials, appears result better might expected had been given. A substantial, variable, died during follow-up causes other cancer. optimal radiation technique (particularly respect mediastinal irradiation) remain uncertain.