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IIIB期NSCLC的治疗

根据监测、流行病学和结局数据库, IIIB期NSCLC的发病率约为17.6%[1]。临床分期为IIIB期NSCLC的多数患者5年生存率为3%-7%[2]。一些小规模病例分析发现原发肺叶仅有卫星结节的T4,N0-1期患者的5年生存率为20%[3][4]。[ 证据等级:3iiiA​]

IIIB期NSCLC的标准治疗选择

IIIB期NSCLC​的标准治疗选择包括:

通常IIIB期NSCLC患者单独手术获益不佳,最好选用初期化疗、化疗联合放疗或单独放疗,具体选择需考虑下列因素:

肿瘤侵犯部位。

患者体能状况(PS)。

体能状况较佳的多数患者适合行联合化放疗,但下列患者除外:

一些T4,N0患者可选用综合治疗与手术,类似于上沟瘤患者。

序贯或同步放化疗

对不可切除III期NSCLC患者的很多随机研究发现术前或同步含顺铂化疗加胸部放疗与单独放疗相比改善患者生存。虽然不可切除IIIB期患者可能受益于放疗,但长期预后总体较差,常出现局部和全身复发。一些前瞻性随机临床试验评估了序贯或同步放化疗的效果。

证据(序贯或同步放化疗):

单独放疗

单独放疗,序贯或同步放化疗可能有益于局部晚期不可切除III期NSCLC患者。但尽管同步放化疗的生存获益最大,其毒性反应发生率也增加。

预后:

传统剂量放疗与分割放疗(每日每次1.8-2.0Gy,6-7周总量60-70Gy)使得患者的长期生存获益5%-10%,结果可复制,且明显缓解症状[12]

证据(放疗治疗局部晚期不可切除肿瘤):

放疗可缓解NSCLC患者的局部受累症状,例如:

气管、食管或支气管压迫。

疼痛。

声带麻痹。

咯血。

上腔静脉综合征。

有时可用经支气管镜激光治疗和(或)近距离放射治疗缓解近端梗阻性病变[14]

证据(放疗作为姑息疗法):

身体状况评分较差的IIIB期患者可选用胸部放疗缓解肺部症状(例如咳嗽、呼吸困难、咯血或胸痛等)[12]。[ 证据等级:3iiiC](更多信息请参考PDQ总结 心肺综合征疼痛​)。

处于临床评估阶段的治疗选择

因IIIB期NSCLC患者的总结果较差,故这些患者可参与临床试验,可能有助于改善疾病控制。

处于临床评估阶段的治疗选择包括:

目前开展的临床试验

现招募 IIIB期非小细胞肺癌​​患者的美国临床研究请参见美国NCI癌症临床研究列表,可根据部位、药物、干预或其他标准进行筛选。

NCI网站提供关于临床试验的基本信息。 

参考文献

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