Edinburgh Cancer Centre, NHS Lothian and University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Nat Rev Clin Oncol. 2012 Oct;9(10):591-8. doi: 10.1038/nrclinonc.2012.135. Epub 2012 Aug 28.
Over the past decade, concomitant chemotherapy and radiotherapy has become the established treatment for patients with stage III non-small-cell lung cancer (NSCLC). Unfortunately, many patients with NSCLC are too old or have multiple comorbidities to withstand such aggressive treatments. Attempts to improve outcomes have included studies of radiotherapy dose escalation and new chemotherapy combinations, as well as adding biological agents and cancer vaccines to existing regimens. Technical radiotherapy modifications, including intensity-modulated radiotherapy and particle beam therapy, have also been investigated. Given the number of potential advances to current models of treatment development, phase III trials of any single new treatment can take years to complete, which is inadequate. To advance research within shorter timescales to improve patient outcomes, we need methods of improving clinical trial accrual, which might require changes in models of research governance, cooperative group activity, trial design and patient consent.
在过去的十年中，同步放化疗已成为 III 期非小细胞肺癌（NSCLC）患者的既定治疗方法。不幸的是，许多 NSCLC 患者年龄太大或合并多种疾病，无法承受这种激进的治疗。为了提高疗效，已经进行了放疗剂量递增和新的化疗联合方案的研究，以及在现有方案中添加生物制剂和癌症疫苗。还研究了技术放射治疗的改进，包括调强放疗和粒子束治疗。鉴于当前治疗开发模型中可能有许多潜在的进展，任何单一新治疗的 III 期试验都需要数年时间才能完成，这是不够的。为了在更短的时间内推进研究，以改善患者的预后，我们需要改进临床试验入组的方法，这可能需要改变研究治理、合作组活动、试验设计和患者同意的模式。
