Pinder-Schenck M, Bepler G
Thoracic Oncology, Department of Medicine and Oncological Sciences, University of South Florida, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33620, USA.
Minerva Chir. 2009 Dec;64(6):611-28.
Even with aggressive surgical treatment, relapse rates remain high for patients with resectable non-small cell lung cancer (NSCLC). In an effort to improve survival in these patients, numerous clinical trials have evaluated neoadjuvant and adjuvant chemotherapy. Three large, randomized clinical trials and two meta-analyses have demonstrated a survival benefit for adjuvant cisplatin-based chemotherapy compared to surgery alone. Adjuvant chemotherapy has become the standard of care for patients with resected NSCLC. A neoadjuvant approach offers several potential advantages over adjuvant therapy, including earlier treatment of micrometastatic disease, improved compliance and pathologic confirmation of efficacy. Randomized trials have shown neoadjuvant therapy to be feasible and safe and some studies have yielded promising efficacy. The applicability of these results has been limited due to patient heterogeneity, imprecise staging and lack of standardization with respect to inclusion of radiation therapy. With novel agents, improved staging, better supportive care and relevant molecular markers, a neoadjuvant strategy is promising for future clinical trials in NSCLC.
即使采用积极的手术治疗，可切除的非小细胞肺癌（NSCLC）患者的复发率仍然很高。为了提高这些患者的生存率，众多临床试验对新辅助化疗和辅助化疗进行了评估。三项大型随机临床试验和两项荟萃分析表明，与单纯手术相比，基于顺铂的辅助化疗可带来生存获益。辅助化疗已成为可切除NSCLC患者的标准治疗方案。新辅助治疗方法相对于辅助治疗具有几个潜在优势，包括更早治疗微转移疾病、提高依从性以及对疗效进行病理确认。随机试验表明新辅助治疗是可行且安全的，一些研究也取得了有前景的疗效。由于患者异质性、分期不精确以及在纳入放射治疗方面缺乏标准化，这些结果的适用性受到了限制。随着新型药物、改进的分期、更好的支持治疗以及相关分子标志物的出现，新辅助策略在NSCLC未来的临床试验中很有前景。
