临床上，肺癌晚期患者出现局限转移灶后，医生往往采用外科手术直接切除肿瘤组织的办法治疗癌症患者。但这一做法并不能有效地遏制癌症患者病情的发展，为了控制肿瘤的复发，临床医生们经常采用放射治疗（放疗）的方法以希望降低患者肿瘤复发的风险。
但近来，一项刊登在Cancer杂志上的研究表明：放射治疗应该有针对性的开展，因为放疗并不能延长肺癌老年患者的存活时间。对那些已经接受外科切除手术治疗的肺癌晚期患者，常规的放射治疗应该慎重。
来自美国纽约西奈山医学院的研究人员开展的这项研究充分分析了放射治疗是否能延长肺癌患者的生存时间。
研究者调查分析了1992年至2005年间，共1,307例肺癌晚期病例。研究人员发现：在这1,307例肺癌晚期病患中，有710位病人（约占总人数的54％）在接受完外科手术治疗后又进行了放射治疗，但数据表明这些人的存活时间比那些没有接受放射治疗的患者并没有显著延长。
研究人员强调：在我们确定是否要对肺癌患者进行放射治疗之前，我们应该认真考虑放疗是否能延长患者存活时间，放疗是否会给患者带来潜在好处。(生物谷 Bioon.com)
doi:10.1002/cncr.26585
PMC:
PMID:
Postoperative radiotherapy for elderly patients with stage III lung cancer
Juan P. Wisnivesky MD, DrPh1,2,*, Ethan A. Halm MD, MPH3,4, Marcelo Bonomi MD5,6, Cardinale Smith MD5,6, Grace Mhango MPH1, Emilia Bagiella PhD7
BACKGROUND:
The potential role of postoperative radiation therapy (PORT) for patients who have completely resected, stage III nonsmall cell lung cancer (NSCLC) with N2 disease remains controversial. By using population-based data, the authors of this report compared the survival of a concurrent cohort of elderly patients who had N2 disease treated with and without PORT.
METHODS:
By using the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records, 1307 patients were identified who had stage III NSCLC with N2 lymph node involvement diagnosed between 1992 and 2005. Propensity scoring methods and instrumental variable analysis were used to compare the survival of patients who did and did not receive PORT after controlling for selection bias.
RESULTS:
Overall, 710 patients (54%) received PORT. Propensity score analysis indicated that PORT was not associated with improved survival in patients with N2 disease (hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.97-1.27). Analyses that were limited to patients who did or did not receive chemotherapy, who received intermediate-complexity or high-complexity radiotherapy planning, or adjusted for time trends produced similar results. The instrumental variable estimator for the absolute improvement in 1-year and 3-year survival with PORT was ?0.04 (95% CI, ?0.15 to 0.08) and ?0.08 (95% CI, ?0.24 to 0.15), respectively.
CONCLUSIONS:
The current data suggested that PORT is not associated with improved survival for elderly patients with N2 disease. These findings have important clinical implications, because SEER data indicate that a large percentage of elderly patients currently receive PORT despite the lack of definitive evidence about its effectiveness. The potential effectiveness of PORT should be evaluated further in randomized controlled trials.
