Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Av. Isabel la Católica 1 50009. Zaragoza, Spain.
Transl Lung Cancer Res. 2015 Apr;4(2):191-7. doi: 10.3978/j.issn.2218-6751.2014.06.01.
Adjuvant chemotherapy (AC) plays now a significant role in the treatment of resected non-small cell lung cancer (NSCLC) patients and has become standard in clinical practice. It took more than two decades of clinical research to show its value, but it is has been well established that its benefit translates into a 4-5% absolute increase in 5-year survival according to published meta-analysis. This improvement is obtained with two-drug, Cisplatin-based regimens (multiples choices are acceptable but vinorelbine is the drug with more reported evidence) and usually four courses are recommended. Survival increase is restricted to cases in which there is involvement of lymph nodes (both N1 and N2 levels). For N0 cases AC might be considered, with a lower level of evidence, for tumors larger than 4 cm in diameter. At the present time, molecular predictive factors and gene signatures are investigational. Patient selection is of paramount importance. Proper recovery from surgery and the absence of major comorbidities are essential features. Toxicity is significant, but manageable and transient. Neutropenia is the most relevant side effect due to the risk of febrile neutropenia. The role of timing of administration, adjuvant radiotherapy (RT) and of newer drugs under evaluation is also reviewed.
辅助化疗（AC）在治疗可切除的非小细胞肺癌（NSCLC）患者中现在发挥着重要作用，并且已成为临床实践的标准。经过二十多年的临床研究，其价值才得以体现，但已明确其益处可转化为根据已发表的荟萃分析，5 年生存率提高 4-5%。这种改善是通过基于顺铂的两药方案（多种选择是可以接受的，但长春瑞滨是报道证据最多的药物）实现的，通常建议使用四个疗程。生存的增加仅限于淋巴结受累的情况（N1 和 N2 水平均受累）。对于 N0 病例，如果肿瘤直径大于 4 厘米，且证据水平较低，可以考虑辅助化疗。目前，正在研究分子预测因素和基因特征。患者选择至关重要。手术后适当恢复且无重大合并症是必要的特征。毒性是显著的，但可管理且短暂。中性粒细胞减少是最相关的副作用，因为存在发热性中性粒细胞减少的风险。还回顾了给药时间、辅助放疗（RT）以及正在评估的新药的作用。
