Chakravarthy A, Johnson D, Choy H
Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Oncology (Williston Park). 1999 Oct;13(10 Suppl 5):93-100.
Lung cancer is the leading cause of cancer death in the United States. Surgery is the treatment of choice for early stage patients. Despite radical surgery, patients with early stage lung cancer remain at risk for recurrence. The role of adjuvant therapy remains to be clearly defined. Locally advanced non-small-cell lung cancer is too extensive for surgical resection, yet does not show evidence of metastatic disease. Historically, these patients were treated with radiation alone. More recent studies have provided the rationale for combining radiation with chemotherapy for patients with good performance status who have locally advanced disease. For patients with marginally resectable tumors, treatment is often given preoperatively (neoadjuvant) as a means of shrinking the tumor to make it resectable. In patients with clearly unresectable disease, radiation with chemotherapy has been established as better than either modality alone. Palliative radiation alone can be used for patients who cannot tolerate this aggressive approach. The optimal sequencing, as well as the best chemotherapeutic agent to use, remains under investigation. Some of the newer agents showing promise in the treatment of non-small-cell lung cancer include paclitaxel (Taxol) and carboplatin (Paraplatin). Other agents that are currently under investigation include topotecan, gemcitabine, and vinorelbine (Navelbine).
肺癌是美国癌症死亡的主要原因。手术是早期患者的首选治疗方法。尽管进行了根治性手术，但早期肺癌患者仍有复发风险。辅助治疗的作用仍有待明确界定。局部晚期非小细胞肺癌范围太广，无法进行手术切除，但尚无转移疾病的证据。从历史上看，这些患者仅接受放射治疗。最近的研究为身体状况良好的局部晚期疾病患者将放疗与化疗联合使用提供了理论依据。对于肿瘤边缘可切除的患者，通常在术前进行治疗（新辅助治疗），以缩小肿瘤使其可切除。对于明确不可切除的疾病患者，放疗联合化疗已被证明比单独使用任何一种方式都更好。单独的姑息性放疗可用于无法耐受这种积极治疗方法的患者。最佳的治疗顺序以及最佳的化疗药物仍在研究中。一些在非小细胞肺癌治疗中显示出前景的新型药物包括紫杉醇（泰素）和卡铂（顺铂）。目前正在研究的其他药物包括拓扑替康、吉西他滨和长春瑞滨（诺维本）。
