IA与IB期NSCLC的标准治疗选择

IA期NSCLCIB期NSCLC​的标准治疗选择包括:

对于已经完全切除的I期NSCLC,目前未发现化疗与放疗改善预后。

手术

​手术是I期NSCLC患者的首选治疗。可根据情况选择肺叶切除术或肺段切除术、楔形切除术或袖状切除术。肺功能受损的患者适合行原发肿瘤肺段切除术或楔形切除术。术前应详细评估患者的整体病情,尤其是肺储备功能,这对于考量手术获益至关重要。术后即刻死亡率与年龄相关,肺叶切除术的死亡率约为3%-5%[1]

证据(手术):

证据局限性(手术):

局灶性与区域性NSCLC患者行手术的有效性结论受限于迄今参与人数较少和试验的潜在方法学缺陷。

辅助治疗

很多术后患者发生区域或远处转移[7]。这些患者适合纳入评估术后化疗或放疗的临床试验。目前尚未证实术后化疗或放疗可改善已完全切除肿瘤的I期NSCLC患者的预后。

有研究评估了术后(辅助)放疗(PORT)的意义,发现并不能改善完全切除肿瘤的I期NSCLC患者的预后[8]

证据(辅助放疗):

需行进一步分析判断这些预后是否可能随着技术进步、目标病变体积更明确和放疗射野中心脏受累体积更小而变化。

根据一项荟萃分析的结果,除临床试验之外,不建议I期NSCLC患者在完全切除术后行化疗[9][10]。[ 证据等级:1iiA​]

证据(对I期NSCLC的辅助化疗):

​有充分证据表明术后化疗对II期或IIIA期NSCLC患者有效,但术后化疗对IB期NSCLC的作用尚不明确。

证据(对IB期NSCLC的辅助化疗):

对于观察到的生存时间差异程度,CALGB-9633的效力可能不足以检出轻度但有临床意义的生存率改善。此外,卡铂联合顺铂治疗可能影响结果。目前尚无可靠证据证实术后化疗延长IB期NSCLC患者的生存时间[18]。[ 证据等级:1iiA​]

放疗

可手术切除但有手术禁忌或肺储备功能良好但无法行手术的I期患者可选择治愈性放疗。主要放疗方法为用兆伏级设备对已知肿瘤中平面行约60 Gy分割放疗。原发肿瘤锥形束野的加量照射常用于强化对肿瘤的局部控制。为得到最佳治疗效果,需使用模拟器进行详细的治疗计划,准确了解目标体积,尽可能避开关键的正常结构。

预后

两项大型回顾性放疗病例分析发现无法行手术的患者接受决定性放疗后5年生存率分别为10%与27%[19][20]。两项病例分析均发现T1,N0肿瘤患者的预后较好,其5年生存率分别为60%与32%。

证据(放疗):

很多患者因存在增加围手术期风险的合并中而无法行标准切除术。此时这些患者可考虑观察与放疗[22][23][24]。非随机观察研究对比了切除术、放疗与观察的治疗结果,发现观察组患者的生存时间偏短、死亡率偏高[22]。有很多放疗方法可选,包括传统的外部放疗、立体定向全身放疗等,目前因对比性研究的可靠数据有限,尚不明确产生最佳效果的放疗方法[23][24]

处于临床评估阶段的治疗选择

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 I期非小细胞肺癌​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。 

参考文献

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