IIA与IIB期NSCLC的标准治疗选择

IIA期NSCLCIIB期NSCLC​的标准治疗选择包括:

尚未发现辅助放疗改善II期NSCLC患者的预后。

手术

手术是II期NSCLC患者的首选治疗。可根据情况选择肺叶切除术、肺切除术或肺段切除术、楔形切除术或袖状切除术。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。不考虑术后即刻死亡率和术后死亡率与年龄相关之外,肺切除术的死亡率约为5%-8%,肺叶切除术的死亡率约为3%-5%。

证据(手术):

证据局限性(手术):

局灶性与区域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。

一些临床试验研究了术前化疗的作用。术前化疗的潜在获益包括:

减少肿瘤体积 ,利于手术切除。

早期根治微转移灶。

提高患者的耐受性。

但术前化疗有可能延误治愈性手术。

证据(新辅助化疗):

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II期患者可选择治愈性放疗[16]。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

PS较佳的患者中,如能完成治愈性放疗疗程,则预期3年生存率为20%。

证据(放疗):

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 II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

1. Manser R, Wright G, Hart D, et al.: Surgery for early stage non-small cell lung cancer. Cochrane Database Syst Rev (1): CD004699, 2005.[PUBMED Abstract]

2. Allen MS, Darling GE, Pechet TT, et al.: Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81 (3): 1013-9; discussion 1019-20, 2006.[PUBMED Abstract]

3. Burdett SS, Stewart LA, Rydzewska L: Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database Syst Rev (3): CD006157, 2007.[PUBMED Abstract]

4. Gilligan D, Nicolson M, Smith I, et al.: Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet 369 (9577): 1929-37, 2007.[PUBMED Abstract]

5. PORT Meta-analysis Trialists Group.: Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev (2): CD002142, 2005.[PUBMED Abstract]

6. Martini N, Bains MS, Burt ME, et al.: Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 109 (1): 120-9, 1995.[PUBMED Abstract]

7. Winton T, Livingston R, Johnson D, et al.: Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352 (25): 2589-97, 2005.[PUBMED Abstract]

8. Arriagada R, Bergman B, Dunant A, et al.: Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350 (4): 351-60, 2004.[PUBMED Abstract]

9. Pignon JP, Tribodet H, Scagliotti GV, et al.: Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 26 (21): 3552-9, 2008.[PUBMED Abstract]

10. Scagliotti GV, Fossati R, Torri V, et al.: Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 95 (19): 1453-61, 2003.[PUBMED Abstract]

11. Hotta K, Matsuo K, Ueoka H, et al.: Role of adjuvant chemotherapy in patients with resected non-small-cell lung cancer: reappraisal with a meta-analysis of randomized controlled trials. J Clin Oncol 22 (19): 3860-7, 2004.[PUBMED Abstract]

12. Edell ES, Cortese DA: Photodynamic therapy in the management of early superficial squamous cell carcinoma as an alternative to surgical resection. Chest 102 (5): 1319-22, 1992.[PUBMED Abstract]

13. Corti L, Toniolo L, Boso C, et al.: Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma. Lasers Surg Med 39 (5): 394-402, 2007.[PUBMED Abstract]

14. Douillard JY, Rosell R, De Lena M, et al.: Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 7 (9): 719-27, 2006.[PUBMED Abstract]

15. Pepe C, Hasan B, Winton TL, et al.: Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10. J Clin Oncol 25 (12): 1553-61, 2007.[PUBMED Abstract]

16. Komaki R, Cox JD, Hartz AJ, et al.: Characteristics of long-term survivors after treatment for inoperable carcinoma of the lung. Am J Clin Oncol 8 (5): 362-70, 1985.[PUBMED Abstract]

17. Dosoretz DE, Katin MJ, Blitzer PH, et al.: Radiation therapy in the management of medically inoperable carcinoma of the lung: results and implications for future treatment strategies. Int J Radiat Oncol Biol Phys 24 (1): 3-9, 1992.[PUBMED Abstract]

上一页   下一页
译文由 中国国家癌症中心提供
本站由 中国医学科学院医学信息研究所创办并维护 未经许可禁止转载或建立镜像