Duke University, Durham, NC, USA.
J Clin Oncol. 2013 Mar 10;31(8):1029-38. doi: 10.1200/JCO.2012.44.5064. Epub 2013 Feb 11.
Recent advances in systemic cytotoxic and molecularly targeted therapies coupled with technologic strides in radiotherapy have the potential to improve outcomes for patients with non-small-cell lung cancer (NSCLC). Investigations are ongoing to identify optimal cytotoxin-based chemoradiotherapy platforms. The influence of specific histologic and molecular mutation status on the combination of targeted therapies and radiotherapy is also being actively studied. Although there are no convincing randomized phase III data to date supporting a survival advantage for combining molecularly targeted agents with radiation or chemoradiotherapy in the setting of locally advanced NSCLC, phase II and III studies targeted to elderly patients and those with poor performance status are elucidating preferred chemoradiotherapy strategies. Radiotherapy dose escalation did not improve chemoradiotherapy outcomes, although increasing radiation dose-intensity with modern techniques is being actively studied. As modern radiotherapy techniques have been shown to improve outcomes of some patients with limited metastatic disease, investigations are ongoing regarding how to optimally integrate them with standard chemotherapy platforms.
近年来，全身性细胞毒性药物和分子靶向治疗的进步以及放射治疗技术的进步，有可能改善非小细胞肺癌（NSCLC）患者的预后。目前正在进行研究，以确定最佳的基于细胞毒素的放化疗平台。针对特定的组织学和分子突变状态对靶向治疗和放疗联合应用的影响也在积极研究中。尽管目前尚无令人信服的随机 III 期数据支持在局部晚期 NSCLC 中联合使用分子靶向药物与放疗或放化疗可带来生存优势，但针对老年患者和体能状态较差患者的 II 期和 III 期研究正在阐明首选的放化疗策略。虽然增加放疗剂量强度的现代技术正在积极研究中，但放疗剂量升级并未改善放化疗结果。由于现代放疗技术已显示可改善某些局限性转移疾病患者的预后，因此正在研究如何将其与标准化疗平台最佳整合。
