内容紹介
Summary
Four patients with non-small-cell lung cancer(NSCLC), diagnosed with cN2 stage ⅢA disease, by using CT and FDG-PET/CT imaging, received 2 or 3 courses of platinum-based combination chemotherapy. The patients achieved partial response after chemotherapy and underwent surgery. Complete tumor resection was performed via upper lobectomy for 3 patients, but in 1 patient, interlobar metastatic lymph nodes remained after middle and lower bilobectomy. Two courses of postoperative chemotherapy were administered to 3 patients, but 1 patient could not receive postoperative chemotherapy due to complications. One patient, in whom lymph node metastasis completely disappeared after induction chemotherapy, is still alive and without disease recurrence for 7 years. Another patient, with the presence of only one intralobar metastatic lymph node after chemotherapy, died of brain and meningeal metastases, 3 years after surgery. Two other patients, with multiple pN2 lymph nodes after chemotherapy, died of early intrathoracic local relapse, indicating that prognosis is influenced by response to chemotherapy, especially in patients with poor N-downstaging. Improvements in response to induction therapy by using intensive chemotherapeutic regimens, concurrent radiotherapy, and strict patient selection, limited to N-downstaged cases, are needed for successful surgery outcomes in patients with cN2 stage ⅢA NSCLC who have received induction therapy.
要旨
CTとFDG-PET/CTによりcN2 ⅢA期非小細胞肺癌(NSCLC)と診断され,プラチナ製剤を含む2剤併用化学療法を2～3コース実施しPRが得られた4症例に肺切除術を実施した。上葉切除した3例は完全切除できたが,中下葉切除した1例は葉間リンパ節転移が一部遺残した。3例で術後にも2コース化学療法を追加したが,1例は術後合併症のため実施できなかった。術前化学療法後にリンパ節転移がすべて消失していた1例は,術後7年経過し無再発生存中である。肺内リンパ節転移のみ残存していた1例は,脳・髄膜転移を来して術後3年で死亡した。多数の縦隔・肺門リンパ節に転移が残存していた2例は,いずれも早期に局所再発を来して死亡した。結果として治療効果,特にN因子のdownstageが予後を左右していた。cN2 ⅢA期NSCLCに対する導入療法後の手術において,術前化学療法のレジメンの強化や放射線療法の併用などの治療効果を上げる方策と,導入療法後の手術症例をN因子のdownstage症例に限るなどの厳格な選択が必要と思われる。
目次
Four patients with non-small-cell lung cancer(NSCLC), diagnosed with cN2 stage ⅢA disease, by using CT and FDG-PET/CT imaging, received 2 or 3 courses of platinum-based combination chemotherapy. The patients achieved partial response after chemotherapy and underwent surgery. Complete tumor resection was performed via upper lobectomy for 3 patients, but in 1 patient, interlobar metastatic lymph nodes remained after middle and lower bilobectomy. Two courses of postoperative chemotherapy were administered to 3 patients, but 1 patient could not receive postoperative chemotherapy due to complications. One patient, in whom lymph node metastasis completely disappeared after induction chemotherapy, is still alive and without disease recurrence for 7 years. Another patient, with the presence of only one intralobar metastatic lymph node after chemotherapy, died of brain and meningeal metastases, 3 years after surgery. Two other patients, with multiple pN2 lymph nodes after chemotherapy, died of early intrathoracic local relapse, indicating that prognosis is influenced by response to chemotherapy, especially in patients with poor N-downstaging. Improvements in response to induction therapy by using intensive chemotherapeutic regimens, concurrent radiotherapy, and strict patient selection, limited to N-downstaged cases, are needed for successful surgery outcomes in patients with cN2 stage ⅢA NSCLC who have received induction therapy.
要旨
CTとFDG-PET/CTによりcN2 ⅢA期非小細胞肺癌(NSCLC)と診断され,プラチナ製剤を含む2剤併用化学療法を2～3コース実施しPRが得られた4症例に肺切除術を実施した。上葉切除した3例は完全切除できたが,中下葉切除した1例は葉間リンパ節転移が一部遺残した。3例で術後にも2コース化学療法を追加したが,1例は術後合併症のため実施できなかった。術前化学療法後にリンパ節転移がすべて消失していた1例は,術後7年経過し無再発生存中である。肺内リンパ節転移のみ残存していた1例は,脳・髄膜転移を来して術後3年で死亡した。多数の縦隔・肺門リンパ節に転移が残存していた2例は,いずれも早期に局所再発を来して死亡した。結果として治療効果,特にN因子のdownstageが予後を左右していた。cN2 ⅢA期NSCLCに対する導入療法後の手術において,術前化学療法のレジメンの強化や放射線療法の併用などの治療効果を上げる方策と,導入療法後の手術症例をN因子のdownstage症例に限るなどの厳格な選択が必要と思われる。