Jeremic Branislav, Casas Francesc, Dubinsky Pavol, Gomez-Caamano Antonio, Cihoric Nikola, Videtic Gregory, Latinovic Miroslav
Institute of Lung Diseases, Institutski put 4 21204, Sremska, Kamenica, Serbia.
BioIRC Centre for Biomedical Research, Serbia.
J Radiat Res. 2017 May 1;58(3):267-272. doi: 10.1093/jrr/rrx003.
Recent years have witnessed a number of clinical trials in Stage IIIA non-small cell lung cancer (NSCLC) comparing (A) induction chemotherapy (CHT) with induction CHT and radiotherapy (RT), each followed by surgery; (B) either induction CHT or induction RT-CHT, each followed by surgery, with definitive RT-CHT (no surgery). Due to the heterogeneity of patient, tumor and treatment characteristics across these trials, various meta-analyses (MAs) have been performed to define the optimal treatment approach in this setting for this clinical presentation. Six such MAs exist. In spite of the differences between MAs, it appears that RT does not add extra benefit to induction CHT administered before surgery, and that a trimodality (i.e. including surgery) regimen is not superior to definitive concurrent RT-CHT. While one can consider both induction CHT followed by surgery and exclusive concurrent RT-CHT as feasible in this setting, lack of pre-treatment predictive factors identifying patients who might preferentially benefit from a surgical approach limits its use to well-planned clinical trials.
近年来，针对IIIA期非小细胞肺癌（NSCLC）开展了多项临床试验，比较了以下几种治疗方式：（A）诱导化疗（CHT）与诱导化疗联合放疗（RT），每种治疗方式后均进行手术；（B）诱导化疗或诱导放疗联合化疗，每种治疗方式后均进行手术，与根治性同步放化疗（不放疗）。由于这些试验中患者、肿瘤和治疗特征存在异质性，因此已进行了各种荟萃分析（MA），以确定针对这种临床表现的最佳治疗方法。目前有六项此类荟萃分析。尽管荟萃分析之间存在差异，但似乎放疗并未给术前诱导化疗带来额外益处，而且三联疗法（即包括手术）并不优于根治性同步放化疗。虽然在这种情况下可以认为诱导化疗后手术和单纯同步放化疗都是可行的，但缺乏识别可能从手术方法中优先获益的患者的治疗前预测因素，限制了其在精心设计的临床试验中的应用。
