I/II期切除的非小细胞肺癌:辅助/新辅助治疗的指征?
Resected non-small-cell lung cancer stage I/II: indication for adjuvant/neoadjuvant therapy?
作者信息
Hoffmann Hans
机构信息
Department of Thoracic Surgery, Thoraxklinik, the University of Heidelberg, Amalienstrajsse 5, D-69126 Heidelberg, Germany.
出版信息
Lung Cancer. 2004 Aug;45 Suppl 2:S91-7. doi: 10.1016/j.lungcan.2004.07.986.
Complete surgical resection remains the current standard of care for operable patients with stage-I or stage-II non-small-cell lung cancer. However, there is a strong rationale that supports the concept of the addition of systemic therapy to surgery either preoperatively or postoperatively even in patients with early-stage disease, as distant relapse continues to be the dominant form of relapse after surgical resection of NSCLC. Earlier trials of adjuvant therapy have yielded mixed results and the survival gains demonstrated have been modest at best. However, recently presented data of randomised phase-III trials showed an absolute survival benefit of 12-15% for patients with completely resected stage-IB and stage-II NSCLC receiving adjuvant platinum-based chemotherapy compared with observation alone. These trials provide resounding approval for adjuvant chemotherapy being the new standard of care for patients with early-stage non-small-cell lung cancer who have undergone complete resection of the tumour.
对于可手术的Ⅰ期或Ⅱ期非小细胞肺癌患者,完整的手术切除仍是当前的标准治疗方法。然而,有充分的理由支持在术前或术后对手术患者加用全身治疗的理念,即使是早期疾病患者,因为远处复发仍然是NSCLC手术切除后复发的主要形式。早期的辅助治疗试验结果不一,所显示的生存获益充其量也很有限。然而,最近公布的随机Ⅲ期试验数据显示,与单纯观察相比,接受辅助铂类化疗的完全切除的ⅠB期和Ⅱ期NSCLC患者的绝对生存获益为12%-15%。这些试验为辅助化疗成为已完全切除肿瘤的早期非小细胞肺癌患者的新的标准治疗方法提供了有力支持。