Johnson D H
Department of Medicine, Vanderbilt Clinic, Vanderbilt University School of Medicine, Nashville, TN 37232-5536.
Lung Cancer. 1994 Mar;10 Suppl 1:S231-8. doi: 10.1016/0169-5002(94)91686-1.
Up to one-third of newly diagnosed patients with non-small cell lung cancer (NSCLC) present with locally advanced, unresectable disease. Traditionally, these patients have been treated with thoracic radiotherapy alone. Unfortunately, the vast majority eventually die as a result of the development of distant, extrathoracic metastases. While chemotherapy is not particularly effective against clinically obvious metastatic disease, there are good theoretical reasons why the use of this modality in earlier stage disease may be beneficial. Several recently completed pilot studies of combined modality therapy have yielded promising results suggesting improved survival. Indeed, the combination of chemotherapy and thoracic radiotherapy has been shown to be marginally superior to radiotherapy alone in a few recently completed randomized trials. However, this has not been a uniform observation. Thus, further study is needed to firmly establish the role of combined modality treatment in Stage III, unresectable non-small cell lung cancer. In these future trials, the best control arm is a matter of some controversy.
高达三分之一的新诊断非小细胞肺癌（NSCLC）患者表现为局部晚期、无法切除的疾病。传统上，这些患者仅接受胸部放疗。不幸的是，绝大多数患者最终因远处胸外转移的发展而死亡。虽然化疗对临床上明显的转移性疾病并不特别有效，但在疾病早期使用这种治疗方式可能有益，这有充分的理论依据。最近完成的几项联合治疗的试点研究取得了令人鼓舞的结果，表明生存率有所提高。事实上，在最近完成的一些随机试验中，化疗与胸部放疗的联合已被证明略优于单纯放疗。然而，这并非一致的观察结果。因此，需要进一步研究以确定联合治疗在Ⅲ期无法切除的非小细胞肺癌中的作用。在这些未来的试验中，最佳对照臂存在一定争议。
