Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Lung Cancer. 2014 Feb;83(2):117-25. doi: 10.1016/j.lungcan.2013.11.017. Epub 2013 Dec 1.
Latest evidence sets a clear mandate for concurrent chemoradiotherapy as the current standard of care for inoperable stage III non small cell lung cancer patients with good performance status and minimal co-morbidities. However, a survival plateau has been reached, with disappointing results from dose escalation studies using conventional fractionation and studies investigating the addition of systemic doses of chemotherapy delivered before or after concurrent chemoradiotherapy. A review was carried out to address three questions considered fundamental to improving outcome in patients with stage III non-small cell lung cancer: (1) Can radiotherapy regimens be optimised using advanced radiotherapy techniques to improve local control rate and overall survival? (2) Can systemic therapy regimens be optimised to reduce the risk of distant metastases? (3) Should concurrent chemoradiotherapy be considered standard of care for locally advanced non-small cell lung cancer in the elderly? It is clear that further improvement in outcome for these patients will be determined by better local control and by reducing the risk of distant recurrence. Given the technological advances in radiotherapy planning and delivery in recent years plus the abundance of novel targeted therapies exploiting critical oncogenic pathways, further advances in combined drug-radiation treatment for lung cancer seem highly possible.
最新证据明确规定，对于身体状况良好且合并症较少的不可手术的 III 期非小细胞肺癌患者，同步放化疗是目前的标准治疗方法。然而，目前已经达到了生存的高原期，常规分割剂量递增研究和在同步放化疗前后给予全身化疗剂量的研究结果令人失望。进行了一项综述，以解决三个被认为对改善 III 期非小细胞肺癌患者预后至关重要的问题：（1）能否通过先进的放疗技术优化放疗方案以提高局部控制率和总生存率？（2）能否通过优化全身治疗方案降低远处转移的风险？（3）对于老年局部晚期非小细胞肺癌患者，同步放化疗是否应被视为标准治疗？显然，这些患者的预后进一步改善将取决于更好的局部控制和降低远处复发的风险。鉴于近年来放疗计划和实施方面的技术进步，以及利用关键致癌途径的新型靶向治疗药物的大量涌现，肺癌联合药物-放疗治疗的进一步进展似乎非常有可能。
