Dept of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
These authors equally contributed to this manuscript.
Eur Respir J. 2017 Jan 3;49(1). doi: 10.1183/13993003.00764-2016. Print 2017 Jan.
The incidence of stage I and II nonsmall cell lung cancer is likely to increase with the ageing population and introduction of screening for high-risk individuals. Optimal management requires multidisciplinary collaboration. Local treatments include surgery and radiotherapy and these are currently combined with (neo)adjuvant chemotherapy in specific cases to improve long-term outcome. Targeted therapies and immunotherapy may also become important therapeutic modalities in this patient group. For resectable disease in patients with low cardiopulmonary risk, complete surgical resection with lobectomy remains the gold standard. Minimally invasive techniques, conservative and sublobar resections are suitable for a subset of patients. Data are emerging that radiotherapy, especially stereotactic body radiation therapy, is a valid alternative in compromised patients who are high-risk candidates for surgery. Whether this is also true for good surgical candidates remains to be evaluated in randomised trials. In specific subgroups adjuvant chemotherapy has been shown to prolong survival; however, patient selection remains important. Neoadjuvant chemotherapy may yield similar results as adjuvant chemotherapy. The role of targeted therapies and immunotherapy in early stage nonsmall cell lung cancer has not yet been determined and results of randomised trials are awaited.
随着人口老龄化和高危人群筛查的引入，I 期和 II 期非小细胞肺癌的发病率可能会增加。最佳治疗需要多学科合作。局部治疗包括手术和放疗，目前这些治疗方法在特定情况下与（新）辅助化疗联合使用，以改善长期预后。靶向治疗和免疫疗法也可能成为这组患者的重要治疗方式。对于心肺风险低的可切除疾病患者，肺叶切除术仍然是金标准。对于一部分患者，微创技术、保守性和亚肺叶切除术是合适的。越来越多的数据表明，放疗，尤其是立体定向体部放疗，是手术高危候选者的一种有效替代方法。对于手术高风险的患者，这种方法是否也适用于手术条件良好的患者，仍需在随机试验中进行评估。在特定亚组中，辅助化疗已被证明可以延长生存时间；然而，患者选择仍然很重要。新辅助化疗可能会产生与辅助化疗相似的结果。靶向治疗和免疫疗法在早期非小细胞肺癌中的作用尚未确定，正在等待随机试验的结果。
