Crook A, Duffy A, Girling D J, Souhami R L, Parmar M K
Medical Research Council Cancer Trials Office, Cambridge, UK.
Eur Respir J. 1997 Jul;10(7):1552-8. doi: 10.1183/09031936.97.10071552.
As an adjunct to a meta-analysis of chemotherapy for non-small cell lung cancer (NSCLC), a survey was conducted in England and Wales of clinicians' views on the role of chemotherapy in NSCLC and the benefits it would have to offer to lead them to change their practice. Radiotherapists, medical oncologists, surgeons and physicians specializing in thoracic medicine, and physicians of palliative medicine were asked their views on the treatment of three case histories of 65 yr old men: Case 1, resected tumour involving a hilar lymph node (tumour (T)2, node (N)1, metastasis (M)0); Case 2, tumour that had spread to mediastinal lymph nodes bilaterally (T2, N3, M0); and Case 3, metastatic cancer (M1) accompanied by minor haemoptysis. Six hundred and ninety eight (85%) of the 821 clinicians responded. For Case 1, 74% would not recommend any adjuvant treatment, 24% would recommend radiotherapy, and <1% chemotherapy, and there was little expectation that adjuvant treatment would improve survival. For Case 2, 68% would recommend radiotherapy, 11% chemotherapy, and 1% surgery, 7% recommending a combination. Adjuvant treatment, regardless of modality, was expected to improve survival. For Case 3, only 11% would recommend chemotherapy, but 26% if the patient was aged < or = 50 yrs. There was little expectation of survival beyond 1 yr, or of improving survival with chemotherapy. For all three cases, most of those not recommending chemotherapy would require it to achieve substantially improved survival for them to use it routinely. Surgery alone is currently considered sufficient for resectable non-small cell lung cancer. Chemotherapy is rarely recommended for disease of any stage.
作为非小细胞肺癌（NSCLC）化疗荟萃分析的补充，在英格兰和威尔士对临床医生关于化疗在NSCLC中的作用以及化疗可能带来的益处（促使他们改变治疗方式）的观点进行了一项调查。向放射肿瘤学家、医学肿瘤学家、外科医生、胸科专科医生以及姑息医学医生询问了他们对3例65岁男性病例的治疗意见：病例1，肿瘤切除，累及肺门淋巴结（肿瘤（T）2，淋巴结（N）1，转移（M）0）；病例2，肿瘤已双侧扩散至纵隔淋巴结（T2，N3，M0）；病例3，伴有少量咯血的转移性癌（M1）。821名临床医生中有698名（85%）做出了回应。对于病例1，74%的人不建议进行任何辅助治疗，24%的人建议放疗，不到1%的人建议化疗，而且几乎没人期望辅助治疗能提高生存率。对于病例2，68%的人建议放疗，11%的人建议化疗，1%的人建议手术，7%的人建议联合治疗。无论采用何种方式，辅助治疗都有望提高生存率。对于病例3，只有11%的人会建议化疗，但如果患者年龄≤50岁，这一比例为26%。几乎没人期望生存期能超过1年，也不认为化疗能提高生存率。对于所有3个病例，大多数不建议化疗的人认为，只有在化疗能显著提高生存率的情况下，他们才会常规使用化疗。目前认为，对于可切除的非小细胞肺癌，单纯手术就足够了。对于任何分期的疾病，化疗很少被推荐。
