Baik Christina S, Vallières Eric, Martins Renato G
From the University of Washington, Seattle, WA; Swedish Cancer Institute, Seattle, WA.
Am Soc Clin Oncol Educ Book. 2013:320-5. doi: 10.14694/EdBook_AM.2013.33.320.
Patients with confirmed stage IIIA non-small cell lung cancer (NSCLC) represent a very heterogeneous group which includes those with limited microscopic ipsilateral mediastinal lymph node involvement discovered after a surgical resection, as well as those who have radiologically evident bulky subcarinal lymph node involvement at presentation. Different therapeutic options in stage IIIA disease include neoadjuvant chemo- or chemoradiotherapy followed by surgery, primary surgery followed by adjuvant chemotherapy with or without sequential adjuvant radiation therapy or definitive chemoradiation without surgery. The roles of surgery and radiation in stage IIIA disease are controversial, and there is inadequate data from randomized trials to inform the optimal therapeutic strategy. In contrast, chemotherapy has a clear indication in the curative setting. Data from randomized trials indicates that cisplatin-based chemotherapy should be given in either adjuvant or neoadjuvant settings to patients who are undergoing curative surgical resection and who are candidates for cisplatin therapy. In definitive chemoradiotherapy, cisplatin-based therapy is recommended although a carboplatin-based regimen may be given if patients cannot receive cisplatin. Finally, all patients with stage IIIA NSCLC should be evaluated early in a multidisciplinary setting that includes medical and radiation oncologists and thoracic surgeons with experience in lung cancer therapy.
确诊为IIIA期非小细胞肺癌（NSCLC）的患者构成了一个非常异质性的群体，其中包括那些在手术切除后发现同侧纵隔淋巴结有微小转移的患者，以及那些在初诊时影像学显示隆突下淋巴结有明显肿大的患者。IIIA期疾病的不同治疗选择包括新辅助化疗或放化疗后手术、先行手术然后进行辅助化疗（有或无序贯辅助放疗）或单纯根治性放化疗而不进行手术。手术和放疗在IIIA期疾病中的作用存在争议，且随机试验的数据不足以确定最佳治疗策略。相比之下，化疗在根治性治疗中具有明确的指征。随机试验的数据表明，对于接受根治性手术切除且适合顺铂治疗的患者，应在辅助或新辅助治疗中给予基于顺铂的化疗。在根治性放化疗中，推荐基于顺铂的治疗方案，尽管如果患者不能接受顺铂，也可给予基于卡铂的方案。最后，所有IIIA期NSCLC患者都应尽早在多学科环境中进行评估，该环境包括医学肿瘤学家、放射肿瘤学家以及在肺癌治疗方面有经验的胸外科医生。
