Murren J R, Buzaid A C
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Clin Chest Med. 1993 Mar;14(1):161-71.
Lung cancer remains the most common fatal malignancy, so even modest therapeutic advances are potentially beneficial to large numbers of patients. For patients with regional nodal metastases identified at thoracotomy, adjuvant chemotherapy may be of benefit and additional clinical trials are in progress. Locally advanced disease is present in over a third of patients at diagnosis. For patients with marginally resectable tumors, the preliminary results of the neoadjuvant chemotherapy trials are encouraging and may result in an improvement in the 15% 5-year survival in this group. For patients with locally advanced and unresectable tumors, several but not all studies suggest that the combination of chemotherapy and radiation produces better results than radiation alone. Additional trials are needed to clarify these results. In addition, better methods are needed to maintain local control of unresected tumors. Hyperfractionated radiation schedules and concurrent administration of radiosensitizing chemotherapy drugs appear to be the most promising leads. Effective systemic treatment for patients with disseminated disease remains elusive. Several new classes of drugs, especially taxol and the topoisomerase I poisons, are being introduced and have rekindled hope for improved treatment of this large group of patients.
肺癌仍然是最常见的致命恶性肿瘤，因此即使是适度的治疗进展也可能使大量患者受益。对于在开胸手术中发现有区域淋巴结转移的患者，辅助化疗可能有益，并且正在进行更多的临床试验。超过三分之一的患者在诊断时存在局部晚期疾病。对于肿瘤边缘可切除的患者，新辅助化疗试验的初步结果令人鼓舞，可能会使该组患者15%的5年生存率得到提高。对于局部晚期且无法切除的肿瘤患者，一些（但并非所有）研究表明，化疗与放疗联合使用比单纯放疗效果更好。需要更多试验来明确这些结果。此外，需要更好的方法来维持对未切除肿瘤的局部控制。超分割放疗方案以及同步给予放射增敏化疗药物似乎是最有前景的方法。对于播散性疾病患者，有效的全身治疗仍然难以实现。几种新型药物，特别是紫杉醇和拓扑异构酶I抑制剂正在被引入，为改善对这一庞大患者群体的治疗重新燃起了希望。
