Немелкоклеточный рак легкого с поражением бифуркации трахеи: пневмонэктомия с резекцией бифуркации трахеи или химиолучевая терапия?

Дадыев И.А., Давыдов М.М., Шогенов М.С. и др. Немелкоклеточный рак легкого с поражением бифуркации трахеи: пневмонэктомия с резекцией бифуркации трахеи или химиолучевая терапия? Современная Онкология. 2018; 20 (4): 32–35. DOI: 10.26442/18151434.2018.4.180161

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Dadyev I.A., Davydov M.M., Shogenov M.S. et al. Non-small cell lung cancer with the tracheal bifurcation involvement. Carinal pneumonectomy or chemo-radiation therapy? Journal of Modern Oncology. 2018; 20 (4): 32–35. DOI: 10.26442/18151434. 2018.4.180161

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Аннотация

Цель данного исследования – сравнение непосредственных и отдаленных результатов лечения больных немелкоклеточным раком легкого с опухолевым поражением бифуркации трахеи, которым выполнялась пневмонэктомия с резекцией бифуркации трахеи либо проводилась радикальная химиолучевая терапия (ХЛТ).
Материалы и методы. Мы провели ретроспективное нерандомизированное клиническое исследование с выделением следующих групп больных: 1) пациенты, которым выполнена пневмонэктомия с резекцией бифуркации трахеи (n=65); 2) больные, которым проводилась ХЛТ в радикальном режиме (n=30). Оценка эффективности непосредственных и отдаленных результатов осуществлялась методом статистической обработки при помощи программы Statistic 6.0. Проведен анализ случай–контроль с сопоставлением исследуемых групп.
Результаты. В группе хирургического лечения частота осложнений составила 46,1%. В группе ХЛТ осложнения развились у 13 (43,3%) больных. Показатель общей 1-, 3-, 5-летней выживаемости в группе хирургического лечения составил 56,92, 31,7 и 26,1% соответственно. Показатели 1-, 3- и 5-летней выживаемости в группе пациентов, которым проводилась радикальная ХЛТ, – 31,6, 24,4 и 16,2%.

Ключевые слова: местно-распространенный рак легкого, пневмонэктомия с резекцией бифуркации трахеи, циркулярная резекция бифуркации трахеи, радикальная химиолучевая терапия.

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The aim of the study: the aim of this study was to compare the immediate and long-term results of treatment of patients with non-small cell lung cancer with involvement of tracheal bifurcation, which were underwent pneumonectomy with resection of the tracheal bifurcation or radical chemo-radiation therapy (CRT).
Materials and methods. We conducted a retrospective non-randomized clinical study with following groups of patients: 1) 65 patients who underwent pneumonectomy with resection of the tracheal bifurcation; 2) 30 patients to whom CRT was performed. Evaluation of the effectiveness of immediate and long-term results was carried out by statistical processing using the Statistic 6.0 program. A case-control analysis was performed to compare two groups. The time of the operation, intra- and postoperative complications was estimated depending on the type of resection of the tracheal bifurcation.
Results. The complication rate was 46.1% in the surgical group. In the CRT group complications developed in 13 (43.3%) patients. The overall 1-, 3-, 5-year survival rate in the group of patients with surgical treatment was 56.92, 31.7 and 26.1%, respectively. The median overall survival was 14.5 months. Indicators of 1-, 3-, and 5-year survival in the group of patients who underwent radical CRT were 31.6, 24.4, 16.2%.

Key words: locally advanced lung cancer, pneumonectomy with resection of the tracheal bifurcation, circular resection of the tracheal bifurcation, radical chemo-radiation therapy.

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Список литературы

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1. Dadyev I.A., Davydov M.M., Chekini A.K. i dr. Rezektsiia bifurkatsii trakhei v lechenii bol'nykh nemelkokletochnym rakom legkogo (obzor literatury). Sib. onkol. zhurn. 2018; 17 (5): 94–105. DOI: 10.21294/1814-4861-2018-17-5-94-105 [in Russian]
2. Mitchell JD, Mathisen DJ, Wright CD et al. Resection for bronchogenic carcinoma involving the carina: long-term results and effect of nodal status on outcome. J Thorac Cardiovasc Surg 2001: 12–4, 65–71.
3. Yildizeli B, Dartevelle PG, Fadel E et al. Radical resections for T4 lung cancer. Clin North Am 2002; 82 (3): 573–87.
4. Detterbeck FC, Jones DR, Kernstine KH, Naunheim KS. American College of Physicians. Lung cancer. Special treatment issues. Chest 2003; 123 (1): 244S–258S.
5. Perrot M, Fadel E, Mercier O et al. Long-term results after carinal resection for carcinoma: does the benefit warrant the risk? Gen Thorac Surg 2006; 131 (1): 81–9.
6. Roviaro G, Vergani C, Maciocco M et al. Tracheal sleeve pneumonectomy: long-term outcome. Lung Cancer 2006; 52 (1): 105–10.
7. Yildizeli B, Dartevelle PG, Fadel E et al. Results of Primary Surgery With T4 Non–Small Cell Lung Cancer During a 25-Year Period in a Single Center: The Benefit is Worth the Risk. Аnn Thorac Surg 2008; 86 (4): 1065–75.
8. Rea F, Marulli G, Schiavon M et al. Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): short and long-term results in a single institution. Lung Cancer 2008; 61: 202–8.
9. Sanli M, Arslan E, Isik AF et al. Carinal sleeve pneumonectomy for lung cancer. Acta Chir Belg 2013; 113 (4): 258–62.
10. Levchenko E.V., Ergnian S.M., Shutov V.A., Barchuk A.S. Khirurgicheskie vmeshatel'stva s tsirkuliarnoi rezektsiei bifurkatsii trakhei pri lechenii bol'nykh so zlokachestvennymi novoobrazovaniiami bronkhov. Khirurgiia. 2016; 1. Vyp. 2. DOI: 10.17116/hirurgia20161216- 2233 [in Russian]
11. Levchenko N.E. Sovershenstvovanie bronkhoplasticheskikh vmeshatel'stv v khirurgii zlokachestvennykh novoobrazovanii legkogo. Avtoref. dis. … kand. med. nauk. SPb., 2016. [in Russian]
12. Macchiarini P, Altmayer M, Go T et al, Hannover Interdisciplinary Intrathoracic Tumor Task Force Group. Technical innovations of carinal resection for nonsmall-cell lung cancer. Ann Thorac Surg 2006; 82 (6): 1989–97; discussion 1997.
13. Gielda BT, Marsh JC, Zusag TW et al. Split-Course Chemoradiotherapy for Locally Advanced Non-small Cell Lung Cancer A Single-Institution Experience of 144 Patients. J Thorac Oncol 2011; 6 (6).
14. Werner-Wasik M, Scott C, Cox JD et al. Recursive partitioning analysis of 1999 Radiation Therapy Oncology Group (RTOG) patients with locally-advanced non-small-cell lung cancer (LA-NSCLC): identification of five groups with different survival Int J Radiat Oncol Biol Phys 2000; 48: 1475–82.
15. Davies AM, Chansky K, Lau DHM et al. Phase II study of consolidation paclitaxel after concurrent chemoradiation in poor-risk stage III non-small-cell lung cancer: SWOG S9712. J Clin Oncol 2006; 24: 5242–6.
16. Ready N, Jänne PA, Bogart J et al. Chemoradiotherapy and gefitinib in stage III non-small cell lung cancer with epidermal growth factor receptor and KRAS mutation analysis: Cancer and Leukemia Group B (CALGB) 30106, a CALGB-stratified phase II trial. J Thorac Oncol 2010; 5: 1382–90.
17. Kuz'min I.V., Kharchenko V.P., Gurevich L.A. i dr. Luchevoi pnevmonit i pnevmofibroz posle kombinirovannogo organosokhraniaiushchego lecheniia bol'nykh rakom legkogo. Ros. onkol. zhurn. 1998; 4; 43–8. [in Russian]
18. Saunders MI, Dische S, Barrett A et al. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomized multi-center trial. Radiother Oncol 1999; 52: 137–48.
19. Brunelli A, Al Refai M, Monteverde M et al. Predictors of early morbidity after major lung resection in patients with and without airflow limitation. Ann Thorac Surg 2002; 74: 999–1003.
20. Varela G, Brunelli A, Rocco G et al. Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. Eur J Cardiothorac Surg 2006; 30: 644–8.
21. Galetta D, Spaggiari L. Early and Long-Term Results of Tracheal Sleeve Pneumonectomy for Lung Cancer After Induction Therapy. Ann Thorac Surg 2018; 105 (4): 1017–23. DOI: 10.1016/j.athoracsur.2017.11.052

Авторы

И.А.Дадыев*1,2, М.М.Давыдов1, М.С.Шогенов1, А.Г.Абдуллаев1, М.А.Ибраев1, А.А.Филатов1

1 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*islamik_07@mail.ru

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I.A.Dadyev*1,2, M.M.Davydov1, M.S.Shogenov1, A.G.Abdullaev1, M.A.Ibraev1, A.A.Filatov1

1 N.N.Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23;
2 A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*islamik_07@mail.ru

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