Stinchcombe Thomas E, Socinski Mark A
Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.
Drugs. 2007;67(3):321-32. doi: 10.2165/00003495-200767030-00001.
Lung cancer is the leading cause of cancer death among men and women in the US. Surgical resection is potentially curative; however, even after complete resection many patients experience systemic recurrence and subsequently die of their disease. As a means of reducing the chances of recurrence there has been significant interest in combining chemotherapy with surgical resection. Recently, several large phase III clinical trials have demonstrated a significant survival benefit with adjuvant or postoperative cisplatin-based chemotherapy. Use of preoperative or induction chemotherapy has also been an area of active investigation; however, the trials that have demonstrated a survival benefit were small in size, and there has not been widespread acceptance of this treatment approach. The trials of induction chemoradiotherapy have generally been performed in patients with locally advanced disease, frequently in patients with involvement of the level 2 mediastinal lymph nodes (N2). The results of the recent US Intergroup trial, 0139, which compared induction chemoradiotherapy followed by surgical resection versus nonsurgical therapy with chemoradiotherapy in patients with resectable stage IIIA-N2 disease, revealed equivalent overall survival between the two treatment approaches. The results of an unplanned subset analysis of patients who were treated with lobectomy in the surgical arm have generated significant interest and debate. When the strategy of induction therapy is used, pathological clearance of the mediastinal lymph nodes is a significant prognostic factor for overall survival. Current investigations are attempting to determine the optimal method of assessing this critical prognostic factor. The toxicity, efficacy and proper selection of patients for induction therapy, particularly induction chemoradiotherapy, will be assessed in ongoing and future clinical trials.
肺癌是美国男性和女性癌症死亡的主要原因。手术切除有可能治愈；然而，即使在完全切除后，许多患者仍会出现全身复发，随后死于该疾病。作为降低复发几率的一种手段，人们对化疗与手术切除相结合产生了浓厚兴趣。最近，几项大型III期临床试验表明，基于顺铂的辅助化疗或术后化疗具有显著的生存获益。术前或诱导化疗的应用也是一个积极研究的领域；然而，那些显示出生存获益的试验规模较小，并且这种治疗方法尚未得到广泛认可。诱导放化疗试验通常在局部晚期疾病患者中进行，常见于累及2级纵隔淋巴结（N2）的患者。最近美国肿瘤协作组0139试验的结果比较了诱导放化疗后手术切除与不可切除III A - N2期疾病患者的非手术放化疗，结果显示两种治疗方法的总生存率相当。对手术组中接受肺叶切除术的患者进行的一项非计划亚组分析结果引起了极大关注和争论。当采用诱导治疗策略时，纵隔淋巴结的病理清除是总生存的一个重要预后因素。目前的研究正在试图确定评估这一关键预后因素的最佳方法。诱导治疗，尤其是诱导放化疗的毒性、疗效以及患者的正确选择，将在正在进行和未来的临床试验中进行评估。
