Robinson Lary A, Ruckdeschel John C, Wagner Henry, Stevens Craig W
Division of Cardiovascular and Thoracic Surgery, Thoracic Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612-9497, USA.
Chest. 2007 Sep;132(3 Suppl):243S-265S. doi: 10.1378/chest.07-1379.
Stage IIIA non-small cell lung cancer represents a relatively heterogeneous group of patients with metastatic disease to the ipsilateral mediastinal (N2) lymph nodes and also includes T3N1 patients. Presentations of disease range from apparently resectable tumors with occult microscopic nodal metastases to unresectable, bulky multistation nodal disease. This review explores the published clinical trials to make treatment recommendations in this controversial subset of lung cancer.
DESIGN, SETTING, AND PARTICIPANTS: Systematic searches were made of MEDLINE, HealthStar, and Cochrane Library databases up to May 2006, focusing primarily on randomized trials, with inclusion of selected metaanalyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables.
The evidence derived from the literature now appears to support routine adjuvant chemotherapy after complete resection of stage IIIA lung cancer encountered unexpectedly at surgery. However, using neoadjuvant therapy followed by surgery for known stage IIIA lung cancer as a routine therapeutic option is not supported by current published randomized trials. Combination chemoradiotherapy, especially delivered concurrently, is still the preferred treatment for prospectively recognized stage IIIA lung cancer with all degrees of mediastinal lymph node involvement. Current and future trials may modify these recommendations.
Multimodality therapy of some type appears to be preferable in all subsets of stage IIIA patients. However, because of the relative lack of consistent randomized trial data in this subset, the following evidence-based treatment guidelines lack compelling evidence in most scenarios.
IIIA期非小细胞肺癌代表了一组相对异质性的患者，其患有同侧纵隔（N2）淋巴结转移疾病，还包括T3N1患者。疾病表现范围从具有隐匿性微小淋巴结转移的明显可切除肿瘤到不可切除的、肿大的多站淋巴结疾病。本综述探讨已发表的临床试验，以便对这一有争议的肺癌亚组提出治疗建议。
设计、背景和参与者：截至2006年5月，对MEDLINE、HealthStar和Cochrane图书馆数据库进行了系统检索，主要关注随机试验，并纳入了选定的荟萃分析、实践指南和综述。研究设计和结果总结在证据表中。
目前从文献中获得的证据似乎支持对手术中意外发现的IIIA期肺癌完全切除后进行常规辅助化疗。然而，目前已发表的随机试验并不支持将新辅助治疗后再进行手术作为已知IIIA期肺癌的常规治疗选择。联合放化疗，尤其是同步进行，仍然是前瞻性诊断为IIIA期肺癌且伴有不同程度纵隔淋巴结受累的首选治疗方法。当前和未来的试验可能会修改这些建议。
在IIIA期患者的所有亚组中，某种类型的多模式治疗似乎更可取。然而，由于该亚组相对缺乏一致的随机试验数据，以下基于证据的治疗指南在大多数情况下缺乏令人信服的证据。
