NSCLC复发的标准治疗选择

NSCLC复发​的标准治疗选择包括:

放疗可显著缓解局部肿块产生的症状。

一些研究表明转移癌患者行化疗后可有客观缓解,同时生存时间略延长[12]。[ 证据等级:1iiA​] 评估症状反应的研究发现,主观症状好转率大于客观缓解率[13][14]。可向身体状况评分(PS)良好且有症状复发的患者提供含铂类化疗以缓解症状。对于含铂类化疗后复发的患者,可考虑使用二线化疗。

证据(化疗与靶向治疗):

从未吸烟者、女性、东亚裔、腺癌患者或支气管肺泡癌患者应用厄洛替尼和吉非替尼后的客观缓解率较高[23][24][25][26][27][28][29]。肿瘤缓解可能与EGFR酪氨酸激酶域的敏感突变[24][25][26][28][29]和无K-RAS突变有关[27][28][29]。[ 证据等级:3iiiDiii​]免疫组化证实有EGFR蛋白表达或荧光原位杂交证实EGFR基因拷贝数增加的患者生存获益较大[28][29],尽管EGFR免疫组化检测的临床应用存在质疑[30]

第二原发肿瘤的治疗

支气管来源肿瘤切除后的孤立肺转移较为罕见。原发肺癌患者第二原发恶性肿瘤的常见部位包括肺。很难鉴别新病灶是新的原发癌症或转移灶。一些研究发现,出现新病灶多数情况下为第二原发肿瘤,切除术后部分患者可长期生存。故如果第一原发肿瘤已经得到控制,如有可能应尽量切除第二原发肿瘤[31][32]

脑转移的治疗

原发NSCLC肿瘤切除术后出现孤立性脑转移灶且无颅外肿瘤证据的患者可通过手术切除脑转移灶及术后全脑放射治疗(WBRT)实现长期DFS[33][34]。不可切除的脑转移灶可行放疗[10]

因长期生存可能性较小,应按传统方式行放疗,日剂量1.8-2.0 Gy。因此类治疗的毒性反应风险较大,应避免短期日剂量过高(例如大分割放疗)[35]。多数不适于行手术切除的患者应接受传统WBRT治疗。

行切除术及术后放疗的患者中约有50%复发脑转移,其中部分患者适合进一步治疗[8]。 对于部分身体状况评分良好且无颅外进展性转移的患者,可选的治疗方案包括再手术或立体定向放疗[8][10]。 多数患者可考虑继续放疗,但该治疗的缓解作用有限[36]。[ 证据等级:3iiiDiii​]

处于临床评估阶段的治疗选择

很多NSCLC复发患者可参与临床试验。

目前开展的临床试验

现招募 非小细胞肺癌复发​患者的美国临床试验请参见美国NCI癌症临床试验列表,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。 

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