Lara Primo N, Goldberg Zelanna, Davies Angela, Lau Derick H M, Gandara David R
Department of Medicine, University of California, Davis Cancer Center, Sacramento, CA 95817, USA.
Clin Lung Cancer. 2002 May;3 Suppl 2:S42-8. doi: 10.3816/clc.2002.s.013.
Locally advanced or unresectable stage III non-small-cell lung cancer (NSCLC) patients treated with combined-modality therapy with chemotherapy plus thoracic radiation have improved survival compared to those treated with radiotherapy alone. Furthermore, recent studies in good performance status, stage III patients have shown that concurrent chemoradiotherapy improves survival compared to sequential chemoradiotherapy. However, the optimal chemoradiation approach continues to evolve and is the subject of this review. Since the majority of patients completing chemoradiotherapy will succumb to distant metastatic disease, active systemic agents targeting this tumor compartment are required. Recent data suggest that full-dose chemotherapy designed to eradicate distant micrometastases given either as induction or consolidation has the potential to yield improved patient outcomes. Many of these chemotherapeutic agents are also potent radiosensitizers, hence providing enhanced local control. The integration of these chemotherapeutic agents into chemoradiotherapy programs in stage III NSCLC is the focus of current trials. Ongoing research with novel therapeutic agents with activity against distant micrometastases, refined radiation techniques, and enhanced imaging methodologies to aid in accurate staging are being pursued and should lead to improved survival and toxicity outcomes in this disease.
与单纯接受放疗的患者相比，接受化疗加胸部放疗的综合治疗的局部晚期或不可切除的III期非小细胞肺癌（NSCLC）患者生存率有所提高。此外，近期针对身体状况良好的III期患者的研究表明，与序贯放化疗相比，同步放化疗可提高生存率。然而，最佳的放化疗方法仍在不断发展，也是本综述的主题。由于大多数完成放化疗的患者会死于远处转移性疾病，因此需要针对该肿瘤区域的活性全身药物。近期数据表明，旨在根除远处微转移灶的全剂量化疗，无论是作为诱导化疗还是巩固化疗，都有可能改善患者预后。其中许多化疗药物也是强效放射增敏剂，因此可增强局部控制效果。将这些化疗药物整合到III期NSCLC的放化疗方案中是当前试验的重点。目前正在进行针对具有抗远处微转移活性的新型治疗药物、改进的放射技术以及有助于准确分期的增强成像方法的研究，这些研究应能改善该疾病的生存率和毒性结果。
