Рецидивы немелкоклеточного рака легкого после хирургического и комбинированного лечения с послеоперационной лучевой терапией

Abstract

Purpose: To compare the patterns of the relapses after the surgical and combined modality treatment of non-small cell lung cancer (NSCLC) with the postoperative radiotherapy (PORT).
 Material and methods: The comparative evaluation of the patterns of the relapses was carried out in 528 NSCLC patients with the IA–IIIB stage after surgical treatment (n = 174) and combined modality treatment (n = 354) using PORT in the hypofractionation regimen 3 Gy/fraction, 5 times a week, TD 36–39 Gy (EQD2 = 43.2–46.8 Gy, α/β = 3) and classical fractionation 2 Gy/fraction, 5 times a week, TD 44 Gy.
 Results: The local and the regional relapses developed from 2 to 59 months after treatment, most often in the first three years of follow-up (median 15 months). The local and the regional relapses were statistically significantly more frequent in the surgical treatment group (31.6 % vs 7.1 %). The frequency of the distant metastases in the both groups was not statistically different (46.6 % vs 42.3 %), however, in the surgical treatment group, the distant metastases were more often combined with the locoregional relapses (18.4 % vs 4.5 %). Surgery+PORT in comparison with surgical treatment alone reduces the incidence of locoregional recurrence at the central location of the tumor (8.8 % vs 40.0 %), peripheral non-small cell lung cancer (5.2 % vs 26.0 %), with squamous histological type of tumor (8.4 % vs 37.5 %) and in adenocarcinoma (4.6 % vs 26.4 %), regardless of the volume of surgical treatment (pneumonectomy – 7.0 % vs 47, 1 %, p = 0.0002, lobectomy and bilobectomy – 7.1 % vs 20.6 %, p = 0.001, segmentectomy – 7.1 % vs 50.0 %, p = 0.0001). In the subgroup of patients undergoing adjuvant chemotherapy and PORT, the local, regional and locoregional relapses were statistically significantly less common than in the group of non-small cell lung cancer patients who received only adjuvant chemotherapy (3.9 % vs 17.5 %, p = 0.002, 5.4 % vs 23.8 %, p = 0.001, 6.2 % vs 36.5 %, p = 0.0001). The number of combined relapses (local and/or regional relapses + distant metastases) was actually four times less in all subgroups of patients with PORT (4.7 % vs 20.6 %, p = 0.001). 
 Conclusion: PORT as the part of combined treatment of non-small cell lung cancer statistically significantly reduces the incidence of the local, regional, locoregional and combined relapses in the squamous cell lung cancer and adenocarcinoma, central and peripheral localization of the tumor, after surgical treatment in the volume of pneumonectomy, lob-bilobectomy and segmentectomy, and when using with or without adjuvant chemotherapy.