Livingston R B
Division of Oncology, University of Washington School of Medicine, Seattle 98195.
Semin Oncol. 1994 Oct;21(5 Suppl 10):4-11; discussion 11-3.
Historically, the standard treatment for unresectable non-small cell lung cancer was radiation therapy. Data are now accumulating, however, to indicate that combined chemotherapy and radiation therapy is superior to radiation therapy alone, although it remains uncertain whether concurrent chemotherapy with radiation therapy yields better results than a sequential approach. It is clear that surgical resection is feasible in most patients following neoadjuvant chemotherapy with or without radiation therapy, but whether surgery contributes to survival has not been established; a randomized intergroup study in stage IIIa (N2) disease addresses this question. The Southwest Oncology Group reports comparable resectability rates and survival in patients with stage IIIa and IIIb disease who received concurrent chemotherapy and radiation therapy followed by resection. Stage IV disease has traditionally been managed by supportive care alone and chemotherapy. In selected patients, statistically significant effects on survival have been seen in five randomized trials of platinum-based chemotherapy, one of which had a control arm of supportive care alone. As single agents, only carboplatin and vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) have demonstrated a survival advantage over other regimens in randomized trials, although cisplatin appears to produce similar results. Data from French studies indicate that cisplatin plus vinorelbine is superior to vindesine plus cisplatin and to vinorelbine alone. Several agents appear interesting on the basis of reported response rates in phase II trials: these include paclitaxel (Taxol; Bristol-Myers Squibb Co, Princeton, NJ), docetaxel (Taxotere; Rhoône-Poulenc Rorer, Collegeville, PA), irinotecan (CPT-II), edatrexate, and gemcitabine. Response rates are notoriously variable in this disease, however, and correlate poorly with survival effects. Randomized trials are needed to determine the value of these new agents.
从历史上看，不可切除的非小细胞肺癌的标准治疗方法是放射治疗。然而，现在越来越多的数据表明，联合化疗和放射治疗优于单纯放射治疗，尽管同步化疗与放射治疗是否比序贯治疗产生更好的效果仍不确定。很明显，在接受新辅助化疗（无论是否联合放射治疗）后的大多数患者中，手术切除是可行的，但手术是否有助于提高生存率尚未得到证实；一项针对Ⅲa期（N2）疾病的随机组间研究解决了这个问题。西南肿瘤协作组报告称，接受同步化疗和放射治疗后再进行手术切除的Ⅲa期和Ⅲb期疾病患者，其可切除率和生存率相当。传统上，Ⅳ期疾病仅通过支持治疗和化疗来处理。在五项铂类化疗的随机试验中，已观察到对选定患者的生存有统计学显著影响，其中一项试验的对照组仅采用支持治疗。作为单一药物，在随机试验中，只有卡铂和长春瑞滨（诺维本；百时美施贵宝公司，新泽西州普林斯顿；皮尔法伯制药公司，法国巴黎）显示出比其他方案更具生存优势，尽管顺铂似乎也能产生类似的结果。法国研究的数据表明，顺铂加长春瑞滨优于长春地辛加顺铂以及单纯长春瑞滨。根据Ⅱ期试验报告的缓解率，有几种药物似乎很有前景：这些药物包括紫杉醇（泰素；百时美施贵宝公司，新泽西州普林斯顿）、多西他赛（泰索帝；罗纳普朗克·罗瑞尔公司，宾夕法尼亚州科利奇维尔）、伊立替康（CPT-II）、依达曲沙和吉西他滨。然而，众所周知，这种疾病的缓解率差异很大，与生存效果的相关性也很差。需要进行随机试验来确定这些新药的价值。
