Boudaya Mohamed-Sadok, Smadhi Hanène, Marghli Adel, Charmiti Fatma, Ouerghi Sonia, Mohamed Jalel, Brahem Emna, Smati Belhassen, Mestiri Taher, Kilani Tarek
Department of Cardiothoracic Surgery, Abderrahmen Mami University Hospital, Ariana, Tunisia.
Asian Cardiovasc Thorac Ann. 2013 Aug;21(4):432-6. doi: 10.1177/0218492312462576. Epub 2013 Jul 9.
The treatment of patients with locally advanced non-small-cell lung cancer is controversial. Surgery remains the gold standard, even in this group. Neoadjuvant chemotherapy could allow surgical resection in patients initially judged inoperable.
From January 2009 to May 2010, neoadjuvant chemotherapy was indicated in 27 patients with NSCLC (25 men, 2 women). Their mean age was 65 years. The stages were: IIB in 5, IIIA in 17 (6 in stage IIIAN2), IIIB in 2, and IV in 3.
23 patients received neoadjuvant chemotherapy, 2 refused induction treatment, and 2 had impaired status. The neoadjuvant chemotherapy regimen was gemcitabine-cisplatin in 17 patients and vinorelbine-cisplatin in 6. Only 5 patients underwent complete surgical treatment after induction: 1 in stage IIB, 1 in stage IIIAN0, 1 in IIIB, and 2 in stage IV (1 operated brain metastasis, and 1 operated adrenal metastasis). Surgical treatment was not achieved after neoadjuvant chemotherapy in 18 patients because of progressive disease.
Neoadjuvant chemotherapy offers several potential benefits, but it may delay surgery or eliminate eligibility as a surgical candidate. Rigorous patient selection for this type of multimodal treatment is essential.
局部晚期非小细胞肺癌患者的治疗存在争议。即使在这类患者中，手术仍然是金标准。新辅助化疗可以使最初被判定无法手术的患者获得手术切除的机会。
2009年1月至2010年5月，27例非小细胞肺癌患者（25例男性，2例女性）接受了新辅助化疗。他们的平均年龄为65岁。分期情况为：IIB期5例，IIIA期17例（其中IIIA N2期6例），IIIB期2例，IV期3例。
23例患者接受了新辅助化疗，2例拒绝诱导治疗，2例身体状况不佳。新辅助化疗方案为吉西他滨-顺铂的患者有17例，长春瑞滨-顺铂的患者有6例。诱导治疗后仅5例患者接受了完整的手术治疗：IIB期1例，IIIA N0期1例，IIIB期1例，IV期2例（1例为脑转移手术，1例为肾上腺转移手术）。18例患者在新辅助化疗后因疾病进展未实现手术治疗。
新辅助化疗有若干潜在益处，但可能会延迟手术或使患者失去作为手术候选者的资格。对这类多模式治疗进行严格的患者选择至关重要。
