Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
Section of Thoracic Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave, Chicago, IL, USA.
Curr Treat Options Oncol. 2019 Mar 14;20(4):27. doi: 10.1007/s11864-019-0624-7.
Patients with locally advanced non-small cell lung cancer (NSCLC) are treated for cure, but treatment decisions are not straightforward. Chemotherapy is essential due to the high risk of systemic relapse, but local therapy is also required for cure. In the small subset of stage III patients with N0 or N1 disease, surgery is typically the initial therapy and extended resections are frequent. The majority of IIIA patients present with N2 disease and treatment paradigms for these patients are controversial, particularly concerning the role of resection. Surgery has a limited role in bulky IIIA, IIIB, and IIIC disease, which is typically treated with combined systemic therapy and radiation. The authors believe that in resectable IIIA disease, the addition of surgery to multimodality treatment appears to improve local control and overall survival. Induction therapy is essential, and the use of chemotherapy alone or chemoradiotherapy remains an area of debate. Pneumonectomy should be used with caution in IIIA disease, as numerous prospective trials have noted excessive perioperative mortality. The introduction of immunotherapies in this stage may quickly transform treatment decisions.
局部晚期非小细胞肺癌（NSCLC）患者接受治愈性治疗，但治疗决策并不简单。由于全身复发风险高，化疗是必不可少的，但为了治愈，局部治疗也是必需的。在少数 N0 或 N1 期的 III 期患者中，手术通常是初始治疗，广泛切除很常见。大多数 IIIA 患者存在 N2 疾病，这些患者的治疗模式存在争议，特别是关于切除的作用。手术在大体积 IIIA、IIIB 和 IIIC 疾病中的作用有限，这些疾病通常采用联合全身治疗和放疗进行治疗。作者认为，在可切除的 IIIA 疾病中，将手术加入多模式治疗似乎可以改善局部控制和总生存。诱导治疗至关重要，单独化疗或放化疗的应用仍然存在争议。在 IIIA 疾病中应谨慎使用全肺切除术，因为许多前瞻性试验都指出围手术期死亡率过高。免疫疗法在这一阶段的引入可能会迅速改变治疗决策。
