Besse Benjamin, Le Chevalier Thierry
Department de Medicine, Institut Gustave Roussy, Villejuif, France.
Oncology (Williston Park). 2009 May;23(6):520-7.
Despite aggressive surgical management, 5-year survival rates of patients with non-small-cell lung cancer (NSCLC) range from 73% for those with pathologic stage IA to 25% for stage IIIA. Given the low survival rate associated with treatment by surgery alone, numerous trials have investigated the use of induction or adjuvant strategies with chemotherapy or thoracic irradiation, either alone or in combination. A meta-analysis published in 1995 showed that cisplatin-based regimens produce the best adjuvant chemotherapy results in NSCLC patients, and this finding has been validated by three large randomized trials. Neoadjuvant chemotherapy offers theoretical advantages over adjuvant chemotherapy, including improved patient compliance, a smaller primary tumor, and pathologic evaluation of treatment efficacy. However, most large randomized trials of neoadjuvant chemotherapy have failed to show statistically significant results. This article reviews the pros and cons of each strategy, current guidelines, and treatment methods that are being explored.
尽管采取了积极的手术治疗，但非小细胞肺癌（NSCLC）患者的5年生存率差异较大，病理分期为IA期的患者5年生存率为73%，而IIIA期患者则为25%。鉴于单纯手术治疗的生存率较低，众多试验对单独或联合使用化疗或胸部放疗的诱导或辅助策略进行了研究。1995年发表的一项荟萃分析表明，以顺铂为基础的方案在NSCLC患者中产生了最佳的辅助化疗效果，这一发现已得到三项大型随机试验的验证。新辅助化疗相对于辅助化疗具有理论优势，包括提高患者依从性、缩小原发肿瘤以及对治疗效果进行病理评估。然而，大多数新辅助化疗的大型随机试验未能显示出具有统计学意义的结果。本文综述了每种策略的优缺点、当前指南以及正在探索的治疗方法。
