Sanborn Rachel E, Lally Brian E
Providence Portland Medical Center, 4805 NE Glisan Street, 2N35, Portland, OR 97213, USA.
Thorac Surg Clin. 2008 Nov;18(4):423-35. doi: 10.1016/j.thorsurg.2008.08.004.
Since the publication of the meta-analysis in 1995 indicating a potential survival benefit with adjuvant cisplatin-based chemotherapy for patients with resected NSCLC, the management of patients with resected NSCLC and N2 disease involvement has evolved dramatically. The delivery of systemic therapy in the postoperative setting remains difficult, however, because tolerance for the toxicities of chemotherapy is reduced by recovery from surgery itself. Even with a proven survival benefit with adjuvant chemotherapy, cure is not guaranteed, and most patients die from relapse of their cancer. Optimization of treatment through the administration of neoadjuvant therapy, application of more modern radiotherapy techniques, and combined-modality therapy with chemoradiation or molecularly targeted agents are areas currently under active investigation. Ideally, the improvement of prediction of which patients harbor micrometastatic disease before undergoing surgical resection and the prediction of which patients would benefit from different systemic therapies may help to improve further the chance of cure for NSCLC while at the same time reducing toxicity.
自1995年发表的荟萃分析表明，辅助性顺铂为基础的化疗对可切除的非小细胞肺癌患者有潜在的生存益处以来，可切除的非小细胞肺癌合并N2淋巴结转移患者的治疗方式发生了巨大变化。然而，术后进行全身治疗仍然困难，因为手术本身的恢复会降低对化疗毒性的耐受性。即使辅助化疗已被证明有生存益处，但治愈仍无法保证，大多数患者死于癌症复发。通过新辅助治疗给药、应用更现代的放疗技术以及放化疗或分子靶向药物的联合治疗来优化治疗，是目前正在积极研究的领域。理想情况下，改善对哪些患者在接受手术切除前存在微转移疾病的预测，以及对哪些患者将从不同的全身治疗中获益的预测，可能有助于进一步提高非小细胞肺癌的治愈机会，同时降低毒性。
