To seize the two key non small cell lung cancer radiotherapy

In all lung cancer cases, the proportion of non-small cell lung cancer is high, accounting for about 84%. Data show that the clinical diagnosis, Ⅰ and Ⅱ period of about 34%, Ⅲ, Ⅳ were 28%, 38%. In recent years, with the development of radiotherapy technology, radiotherapy in lung cancer status is getting higher and higher, the effect is getting better and better. Radiation therapy is one of the important treatments for non-small cell lung cancer (NSCLC), with more than 60% of NSCLC patients receiving at least one radiotherapy after diagnosis, according to Wang Green, a Chinese Academy of Medical Sciences. Radiotherapy in different stages of non-small cell lung cancer, the role of the role is also different, the following two key need to pay attention.
 
Radiotherapy is the best choice for early surgery for NSCLC patients
 
In 2014, the US National Comprehensive Cancer Network (NCCN) non-small cell lung cancer treatment guidelines have been updated to the third edition. For early NSCLC, stereotactic ablation radiotherapy (SABR) can be used as a standard treatment for patients who can not surgery or reject surgery , Or as an alternative to wedge resection of the critical surgeon.
 
There is no doubt that surgical resection is still the traditional radical treatment of early NSCLC means. But for patients who can not surgery or refused surgery, radiotherapy is the best choice. Radiotherapy oncology collaboration group (RTOG) 0236 study showed that the 3-year local control rate of patients can be as high as 98%, 3-year survival rate was 56%, median overall survival (OS) period of 48.1 months. A 5-year local control rate for patients with T1 and T2 NSCLC treated with SBRT was 92% and 73%, respectively, and the 5-year survival rates were 72% and 62%, respectively, similar to surgical resection.
 
For patients with early NSCLC who can not undergo surgery or have undergone surgery, radical radiotherapy may be performed, including stereotactic radiotherapy (SABRT), with a recommended biological dose greater than 100 Gy. Some experts say that early NSCLC currently undergoing SBRT is still largely limited to complex early NSCLC, such as a history of chest surgery, a history of chest radiotherapy, and a high risk of surgery or surgery with severe lung disease or severe lung dysfunction Early NSCLC.
 
In addition, it should be noted that the exact stage of lung cancer, especially lymph node staging, is an accurate implementation of SBRT, and achieved good efficacy of an important prerequisite. In clinical practice, PET-CT can improve the accuracy of lymph node staging, and then find the most appropriate treatment for patients.
 
For early NSCLC critical surgery, SABR can be an alternative to wedge resection. A comparative study in the United States found that the efficacy of both. A total of more than 100 patients with TI-2NOMO who were unable to receive lobectomy were enrolled in this study. One group received wedge resection and the other group received SABR. The total dose of SABR was 48 ~ 60GY, 4 to 5 times. The median recurrence rate was lower in the SABR group than in the wedge resection group, while the 2-year OS rate in the wedge resection group was higher than that in the SABR group, but the distant metastasis rate and disease Survival rate was not statistically significant.
 

In fact, SABR compared with the clinical trials of surgery is also the academic community is studying considerations, if the answer is yes, will bring better health economics benefits. Of course, whether SABR can be used to treat patients with the value of surgery, the need for further clarification of clinical trials.

Patients with stage Ⅲ radiotherapy dose recommended 60Gy
 
Experts said that for the operation of stage Ⅲ NSCL patients with standard chemotherapy is concurrent radiotherapy and chemotherapy, high-dose concurrent chemoradiation induction, consolidation of chemotherapy is limited, it is recommended that the use of radiotherapy 60Gy, and chemotherapy to be high and low dose.

RTG0617 study compared standard dose (60Gy) radiotherapy and high dose (74Gy) radiotherapy in 464 patients with stage III NSCLC, and patients received paclitaxel and carboplatin chemotherapy. The results showed that standard dose radiotherapy was better able to control tumor development and Proliferation, and even improve overall survival, high-dose group increased the risk of death by 56%, the risk of local development of the tumor increased by 37%. This may be associated with a high dose group that increases the rate of radiation to the heart or causes an unidentified poisoning response, with two doses of radiotherapy reported a higher proportion of side effects, but the higher incidence of esophagitis in the high-dose group was higher (21% vs. 7%) The
 
To date, a number of randomized controlled studies have compared the efficacy of CCRT and continued radiotherapy in LA-NSCLC. In a meta-analysis published in 2010, six studies were conducted to complete the enrollment before 2003, with sufficient follow-up time. The results showed that CCRT significantly reduced the risk of death in patients [hazard ratio (HR) = 0.84 P = 0.004], improved PFS (HR = 0.90, P = 0.07) and LPFS (HR = 0.77, P = 0.01), but there was no significant difference in distant metastasis (HR = 1.04, P = 0.69). The 3-year and 5-year OS rates were increased by 5.7% and 4.5%, respectively. The 3-year and 5-year PFS rates were increased by 2.9% and 2.2%, respectively. The regional recurrence rates were reduced by 6.0% and 6.1%, respectively, The