Jett James R, Schild Steven E, Keith Robert L, Kesler Kenneth A
Division of Pulmonary Medicine and Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Chest. 2007 Sep;132(3 Suppl):266S-276S. doi: 10.1378/chest.07-1380.
To develop evidence-based guidelines on best available treatment options for patients with stage IIIB non-small cell lung cancer (NSCLC).
A review was conducted of published English-language (abstract or full text) phase II or phase III trials and guidelines from other organizations that address management of the various categories of stage IIIB disease. The literature search was provided by the Duke University Center for Clinical Health Policy Research and supplemented by any additional studies known by the authors.
Surgery may be indicated for carefully selected patients with T4N0-1M0. Patients with N3 nodal involvement are not considered to be surgical candidates. For individuals with unresectable disease, good performance score, and minimal weight loss, treatment with combined chemoradiotherapy results in better survival than radiotherapy (RT) alone. Concurrent chemoradiotherapy seems to be associated with improved survival compared with sequential chemoradiotherapy. Multiple daily fractions of RT when combined with chemotherapy have not been shown to result in improved survival compared with standard once-daily RT combined with chemotherapy. The optimal chemotherapy agents and the number of cycles of treatment to combine with RT are uncertain.
Prospective trials are needed to answer important questions, such as the role of induction therapy in patients with potentially resectable stage IIIB disease. Future trials are needed to answer the questions of optimal chemotherapy agents and radiation fractionation schedule. The role of targeted novel agents in combination with chemoradiotherapy is just starting to be investigated.
制定关于 IIIB 期非小细胞肺癌（NSCLC）患者最佳可用治疗方案的循证指南。
对已发表的英文（摘要或全文）II 期或 III 期试验以及其他组织关于 IIIB 期疾病各类别管理的指南进行综述。文献检索由杜克大学临床健康政策研究中心提供，并由作者所知的任何其他研究加以补充。
对于经过精心挑选的 T4N0 - 1M0 患者，可考虑手术治疗。N3 淋巴结受累患者不被视为手术候选者。对于患有不可切除疾病、体能状态良好且体重减轻最少的个体，联合放化疗治疗比单纯放疗（RT）能带来更好的生存结果。与序贯放化疗相比，同步放化疗似乎与生存改善相关。与标准的每日一次 RT 联合化疗相比，每日多次分割 RT 联合化疗并未显示能提高生存率。最佳化疗药物以及与 RT 联合的治疗周期数尚不确定。
需要进行前瞻性试验来回答重要问题，例如诱导治疗在潜在可切除的 IIIB 期疾病患者中的作用。未来的试验需要回答最佳化疗药物和放疗分割方案的问题。新型靶向药物与放化疗联合的作用才刚刚开始研究。
