非小細胞肺癌に対する術前補助療法の意義　病理学的Ｎ２確認症例の検討

DOI 被引用文献4件 参考文献17件
  • 吉村 雅裕
    兵庫県立成人病センター胸部外科 (呼吸器グループ外科部門)
  • 坪田 紀明
    兵庫県立成人病センター胸部外科 (呼吸器グループ外科部門)
  • 室谷 陽裕
    兵庫県立成人病センター胸部外科 (呼吸器グループ外科部門)
  • 宮本 良文
    兵庫県立成人病センター胸部外科 (呼吸器グループ外科部門)
  • 植田 真三久
    兵庫県立成人病センター胸部外科 (呼吸器グループ外科部門)
  • 中村 宏
    兵庫県立成人病センター胸部外科 (呼吸器グループ外科部門)

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タイトル別名
  • Surgical resection of bulky N2 non-small cell lung cancer after induction therapy.

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From 1985 to 1995, 58 patients with non-small cell lung cancer and bulky mediastinal lymph nodes on chest CT scans received induction therapy consisting of cisplatin (80 mg/m2) and vindesine (3 mg/m2) prior to their operations. Of these 58 patients, 37 with pathological N2 NSCLC were studied to assess the effect of the induction therapy. Of the 37 patients, 10 received one cycle of chemotherapy during 1985 to 1989 and the remaining 27 had 2 or more cycles of the same regimen plus irradiation after 1990 ; nineteen of the 27 patients received 2 to 3 cycles of concurrent chemoradiotherapy which consisted of cisplatin, vindesine and concomitant irradiation (20 Gy) as one cycle. Complete resection was carried out in 21 of the 37 patients with bulky pN2 cases. Complete sterilization of bulky mediastinal nodes was observed histologically in 10 of them. Of these 10 patients with a histologic complete response (CR) of the mediastinal lymph nodes, nine had received concurrent chemoradiotherapy (CCRT) and one had received 4 cycles of chemotherapy alone. Judgment of the effect was focused on the mediastinal lymph nodes rather than the main tumor. The 5-year survival rate was 38.9 % in patients with histologic CR for bulky N2 nodes and this was significantly superior to the result of 9.1 % in patients with partial or minimal response. One cycle of chemotherapy resulted in a poor histologic response and was of no survival benefit. There were 4 major complications postoperatively. Three of 4 were CCRT atients and 2 deaths were related to the induction therapy but the onset of complications was after their discharge, 4 months postoperatively. One patient died at 23 months postoperatively of massive hemoptysis caused by empyema developing from a pulmonary fistula and the other died at 16 months of respiratory failure caused by interstitial pneumonitis.<BR>We conclude that (1) survial was improved in patients with complete resection after histologic sterilization of bulky N2 nodes, (2) two cycles of concurrent chemoradiotherapy produced an excellent response of N2 nodes and the primary tumors, (3) critical postoperative complications often had a late onset after discharge.

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