Fietkau Rainer, Semrau Sabine
Front Radiat Ther Oncol. 2010;42:122-134. doi: 10.1159/000262467. Epub 2009 Nov 24.
Concurrent chemoradiotherapy is presently the standard treatment for stage III inoperable non-small cell lung cancer. Within this treatment framework, conventionally fractionated radiotherapy to a total dose of 60-66 Gy has proven effective. The chemotherapy should be performed using a cisplatin-based regimen or, if contraindicated, carboplatin. The base drug can be combined with another cytostatic, such as etoposide, vinorelbine, paclitaxel or gemcitabine. There is no evidence from randomized clinical trials suggesting that addition of induction chemotherapy or adjuvant chemotherapy to the concurrent chemotherapy regimen improves the prognosis of these patients. Therefore, induction or adjuvant chemotherapy should not be used outside the framework of clinical trials. Age over 70 years and concomitant diseases are not contraindications for concurrent radiochemotherapy per se, but an increased rate of side effects can be expected in such elderly patients or patients with comorbidities. Consequently, these patients require intensive supportive care. Presumably, advanced age is not an adverse prognostic factor per se, but reduced heart and lung function are. Conclusive evidence confirming this assumption is lacking.
同步放化疗目前是Ⅲ期不可切除非小细胞肺癌的标准治疗方法。在这种治疗框架内，常规分割放疗总剂量达60 - 66 Gy已被证明有效。化疗应采用以顺铂为基础的方案，若有禁忌，则使用卡铂。基础药物可与另一种细胞毒性药物联合使用，如依托泊苷、长春瑞滨、紫杉醇或吉西他滨。随机临床试验没有证据表明在同步化疗方案中添加诱导化疗或辅助化疗能改善这些患者的预后。因此，不应在临床试验框架之外使用诱导化疗或辅助化疗。70岁以上及合并其他疾病本身并非同步放化疗的禁忌证，但这类老年患者或合并症患者的副作用发生率可能会增加。因此，这些患者需要强化的支持治疗。高龄本身可能并非不良预后因素，但心肺功能下降则是。目前缺乏证实这一假设的确凿证据。
