Uitterhoeve A L J, Belderbos J S A, van Zandwijk N, Koning C C E
Academisch Medisch Centrum/Universiteit van Amsterdam, Afd. Radiotherapie, Postbus 22.660, 1100 DD Amsterdam.
Ned Tijdschr Geneeskd. 2008 Dec 13;152(50):2709-13.
Patients with a non-small cell lung cancer stage III should preferably be treated with a combination of concomitant radiotherapy and platinum-containing chemotherapy. Concomitant chemoradiation results in improved survival compared to sequential chemoradiation, although this type oftreatment is associated with higher oesophagus toxicity. With concomitant chemoradiation the chemotherapy can be added in several ways to high-dosage radiotherapy, for example in the form of 2 courses of high dose, platinum-containing polychemotherapy once every 3 weeks. Concomitant chemoradiation with just a daily low dose of cisplatin is a good alternative. In view of its low risk of haematological and renal toxicity and ototoxicity and smaller cardiac load this is the therapy of choice and is also highly suitable for elderly patients with comorbidity.
非小细胞肺癌III期患者最好采用同步放化疗联合含铂化疗进行治疗。与序贯放化疗相比,同步放化疗可提高生存率,尽管这种治疗方式与更高的食管毒性相关。采用同步放化疗时,化疗可以多种方式添加至高剂量放疗中,例如每3周进行2个疗程的高剂量含铂联合化疗。单纯每日给予低剂量顺铂的同步放化疗是一种不错的选择。鉴于其血液学、肾毒性和耳毒性风险较低且心脏负担较小,这是首选治疗方法,也非常适合患有合并症的老年患者。