The Shu of non- cellule lung cancer puts to treat behind

The total treatment principle of non- cellule lung cancer still with fight for surgical operation excision for core part, but even is can completely cut off of non- cellule lung cancer, it 5 year, existence rate also only 40% be or so, past comprehensive the treatment has been an important research realm.But the Shu put to treat behind Be main comprehensive treatment one of the meanses already very long-playing in the clinical application.But its effect be subjected to a very great doubt after the British medical science research would 1998 constellate analysis to announce, is a lack of on the other hand clinical proof with insufficiency, is a clinical last and experience and extensive usage on the other hand.
1, study background
The MRC completes in 1998 of constellated analysis to totally tally up 9 three period clinical trial in of 2128 non- cellule lung cancer sufferer, alone the surgical operation set be 661 death in 1072 sufferers, but Shu after put to treat a set 707 death in 1056 sufferers, Shu after put to treat a set of opposite in alone surgical operation set death the risk increase 21%(HR:1.21, 95% CIs:1.08-1.34, P=0.001), the 2 years existence rate lowers 7%.(55% vses 48%)Further second set the analytical manifestation puts to treat to the I to the existence to have after expect or the N0 sufferer Shu obvious of negative function, expect to the III or N2 the sufferers have already lowered the trend that the part relapses a rate but still can't make sure the value of its existence.
The tumor hospital of the local and Chinese medical science science, hospital professor Wang Mei2 and frequently paid a professor to successively report a way 1 set 366 N1s and N2 sufferers, after random ising divided into observation set and Shu put to treat a set, total 69 because of various reason set, observation set and Shu behind put chest of treat the set to relapse a rate to distinguish to 33.2% and 12.7%(P<0.01), observation set of 3 years, 5 years, the existence rate distinguishes to 50.2%, 40.5%, Shu behind put to treat a set distinguish for 51.9%, 43.4%(P=0.56), have elevated trend to the sufferer existence rate of the T3-4 N1 M0.(P=0.092)
2, the Shu puts to treat behind of clinical application
Although lack a well clinical proof, Shu behind put to treat still in each clinical guidebook widely is recommend application, such as NCCN 2005 guidebook recommend at the following circumstance consider for use Shu after put to treat of point to advertise for:The male surgical operation slices good luck, N2 and T4 to cure for good to cut off behind, N1 after cure for good the Shu have already prepare behind disadvantageous factor.(the lymphoid close account sweep insufficiency, wrap a film is invade, several lymphoid knots transfer and slice good luck over near)
The 3 and 2005 years ASTRO meeting lately makes progress
On the ASTRO annual convention in 2005, the Lally that is Yale University reported their researches result, for making sure Shu after put to treat after the II, III expect the NSCLC to cure for good Shu of applied value, the author sieved to confirm to expect NSCLC sufferer's 6953 for the II, III from 1988-2001 years from the SEER database and the sufferer, who put to treat after adopting Shu among them, is among themtotal 3990(48.76%).Observe the index sign is particularly total existence rate(OS) and disease item existence rate(DSS).Go into a set standard main is:After having not accepted a Shu put to treat outside of project a treatment, surgical operation in order to cure for good sex excision, don't include N3 sufferers, in order not to round the influence that the surgical operation period die, after operation March inside death of sufferer all set.The author is in the single factor the analysis detection, tumor diameter>the 3 cms, T cent puts after expect the night(T3, T4), the lymph the knot the masculine gender, 3 or morely of the masculine gender the lymph the knot, the non- bronchus the lung the bubble the cancer, Shu the usage's etc.'s factor for treat all hints total existence rate bad, but get into many factor analysis hour after both have never kept its covariance to learn difference.When to disease particularly item existence rate after analyze the hour the detection regardless is in the single factor analysis or at manily the factor the analysis in the Shu put to treat to all hint DSS bad;Discover N2 sufferers second set single factor analysis Shu's putting to treat behind can raise total existence rate(P=0.0029) and the disease related existence rate(P=0.0336) and put to treat after going Shu of N2 sufferer of 5 year, existence rate for 26.9 the ±s be 1.4%s and put to treat after don'ting go Shu of then for 18.7 the ±s be 2.0%s, disease particularly the item existence rate then distinguishes to 35 ±s 1.6% and 25.8 the ±s be 2.4%s.Many factor analysis manifestation Shu behind put to treat to obviously raise OS to N2 sufferers(HR:0.826, C1:0.736-0.926, P=0.0011)and DDS(HR:0.854, C1:0.751-0.970, P=0.0150).
The author put forward, the Shu is behind put to treat to seem to be to the patient always existence rate combine all benefit influence, but Shu behind put the DFS of treat the set obviously lowers, this may be because after the clinical fulfillment win for have more prepare bad factor of earlier period lung cancer, the doctor puts to treat after usually recommending to go Shu of cause, and for N2 sufferer, Shu after put to treat since can raise a total existence rate can also raise disease particularly item existence rate.
MSKCC Bekelman etc. also reported a research a result, because MRC1998 yearses constellate to analytically announce, Shu behind put to treat of controversy very big, author therefore from the SEER database index from 1988-2001 years, the cure for good of NSCLC sex excision sufferer, among them N0 is 15230 people, N1 is 3972 people, N2 is 1927 people.Total and last N0 sufferers only 7% puts to treat after go the Shu and N1 and N2 distinguish to 45% and 59%;But at relatively to constellate analysis before announce of in 1995 with announce after of the data in 2001 after discover, Shu after put the usage comparison for treat to have to obviously descend, N0 sufferers descend to 3% from 8%, the N1 sufferer descends from 44% to 23%, and N2 sufferers go to 42% from 63%.The author is divided into the sufferer who uses Shu to put to treat behind three age segment:45-59 years old, 60-74 years old, big two age segment after 75 years oldly, result detection regardless putting to treat after being sufferer Shu of 45-59 years old age segment in a N1 still a N2 the sufferers of using a comparison obviously highly in.The author puts forward according to the above result, Shu behind put the usage comparison for treat to have already obviously descended after 1998 constellate analysis announce, but is still to usually use in the sufferer of the N1 and the N2 of treatment means, the young sufferer's Shu after put to treat an usage comparison higher, owing to the rift on the clinical usage, have a necessity to the Shu after put to treat of income and harm do a further research.
MSKCC Vishal etc. compared two Weis to put to treat, the 3D proper form put to treat, the open countryside adjust strong, five wild adjust strong be subjected to the influence for measure to the hearts and the lungs.The author selected by examinations different part of partial later period non- cellule lung cancer's curing for good Shu future trouble be 23 and adopt an above technique each do a treatment plan, total amount is 50.4 Gies.Among them ex- both all adopt a same quantity an allotment and project light upon wild angle, front three all adopt to same alike project light upon wild angle, show that the average heart measures four kinds of methods to distinguish for the 20.6 Gies, 13.4 Gies, 13.4 Gies as a result, 12 Gies;The lung average amount of distinguishes for the 11.8 Gies, 6.6 Gies, 7.4 Gies, 8.5 Gies;The lung V20 distinguishes to 20.3%, 10.1%, 14.0%, 11.0%.The author thinks that the 3D proper form puts to treat and adjusts strong put to treat to compare, obviously lowered the emanation of the heart quantity, for Long Tu bottom and descend leaf's pathological changes, adjust strong put to treat more 3D proper form to put to treat can lower a heart quantity further.Two Weis put to treat of average the lung amount of be obviously high at other techniques, empress three kinds of average lungs of which put to treat a technique measure and make no difference.
4, summarize briefly
Most scholars incline toward since can't put the Shu treats to be all normal regulationses that the NSCLCs cure for good after the Shu a case treatment means behind, also not according to the MRC research give as a result completely negative, but should see the oneself condition which combines a sufferer of the different second set to decide.If the N2 expect, the bronchus slices good luck shortage, T cent expects to be partial to a night and expect existence to grow and cure to bear to be subjected to sex etc., but in order to being in need of a clinical proof, particularly is after expect the sufferer need do further large-scalely three expect a clinical trial with confirm Shu to put to treat curative effect to the N2, because of non- cellule the lung cancer cure for good Shu behind of chemotherapy has already proven its advantage to the existence, experiment the top of the design in response to in consideration of with chemotherapy of comprehensive.
For put to treat to mix up study of disease death after the Shu main concentration in 2, put to treat after on the other hand and directly studying Shu whether increased to mix up disease death, such as Wakelee etc. the ECOG long-term of 3590 sufferers in the clinical trials with visit result with normal the mix up of crowd disease death contrast after discover, Shu after put to treat or Shu after put a chemotherapy and don't increase the disease death of mix up of patient.Then concentrate on an improvement's irradiation's technique on the other hand better protect normal organization.If MSKCC research result show, improve behind of put and treat the technique can betterly protect normal organ, and separate lymphoid knot a prevention irradiation idea to the Zong of the renewal also contributes to the protection of normal organ.