Role of multimodality treatment for lung cancer.
Role of multimodality treatment for lung cancer.
复制标题
多学科治疗对肺癌的作用。
DOI：
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
E. Felip
中科院分区：
文献类型：
--
作者：
R. Rosell;E. Felip
局部晚期非小细胞肺癌（NSCLC）实际上是一种全身性疾病，需要采用多模式方法进行最佳治疗。术前化疗的作用已经确立，目前已成为可切除的ⅢA期非小细胞肺癌的一种公认治疗方法。多项研究探讨了术前化疗后手术的可行性和疗效。所有这些诱导化疗试验都报告了较高的影像学缓解率、较高的可切除率以及完全切除患者生存率的提高。三项已发表的随机试验结果表明，诱导化疗加手术切除的ⅢA期患者生存率优于单纯手术切除。最近，采用同步放化疗的Ⅱ期试验已进行测试，并取得了令人鼓舞的结果。化疗联合胸部放疗已成为局部晚期、不可切除的非小细胞肺癌的一种主要治疗选择。随机试验和后续的荟萃分析表明，与单纯放疗相比，以铂类为基础的联合化疗联合胸部放疗在治疗不可手术的ⅢA期和ⅢB期肺癌时具有明显的生存优势。局部晚期非小细胞肺癌的综合治疗模式不断发展，也是正在进行的研究课题。尽管临床有所进展，但这些患者治疗的许多方面仍有待完全阐明：ⅢA期患者真的需要手术切除吗？改变分割放疗和三维适形放疗的价值是什么？放疗和化疗的最佳顺序是什么？在这方面，新的化疗药物可能在多模式治疗方法中提供额外的益处，正是由于这个原因，各种将新药纳入一线治疗的研究正在进行中。最后，更好地了解肿瘤生物学很可能有助于我们优化治疗。未来，非小细胞肺癌的分子分类在做出与治疗相关的决策时可能会提供一个有用的工具。
Locally advanced non-small cell lung cancer (NSCLC) is, in fact, a systemic disease requiring a multimodality approach for optimal treatment. The role of preoperative chemotherapy has been established and is now an accepted treatment for resectable Stage IIIA NSCLC. Several studies have addressed the feasibility and efficacy of preoperative chemotherapy followed by surgery. All these induction chemotherapy trials have reported a high radiographic response rate, high respectability rate and improved survival in completely resected patients. The findings of three published randomized trials indicate that the survival rate of Stage IIIA patients is better with induction chemotherapy plus surgical resection than with resection alone. More recently, Phase II trials using concurrent chemoradiotherapy have been tested with encouraging results. Chemo-therapy combined with thoracic radiotherapy has emerged as a primary treatment option for locally advanced, unresectable NSCLC. Randomized trials and subsequent meta-analyses have shown a clear survival benefit with platinum-based combination chemotherapy administered with thoracic radiation-as compared to radiation alone-in treating inoperable Stage IIIA and IIIB lung cancer. Combined modality treatment in locally advanced NSCLC continues to evolve and is the subject of ongoing research. Despite clinical advances, many aspects of the management of these patients are yet to be fully clarified: Is surgical resection really necessary for Stage IIIA patients? What is the value of altered-fractionation radiotherapy and three-dimensional conformal radiation therapy? What is the optimal sequencing of radiotherapy and chemotherapy? In this regard, new chemotherapeutic agents may provide additional benefits in the multimodality approach, and it is for this reason that various studies are underway which have incorporated new agents in the front line setting. Finally, a better understanding of the biology of tumors could well help us to optimize treatments. In the future, molecular classification of NSCLC may provide a useful tool when making therapy-related decisions.
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影响因子：
158.5
作者：
DILLMAN, RO;SEAGREN, SL;GREEN, MR
通讯作者：
GREEN, MR
影响因子：
45.3
作者：
Clamon, G;Herndon, J;Green, MR
通讯作者：
Green, MR
影响因子：
45.3
作者：
ALBAIN, KS;RUSCH, VW;LIVINGSTON, RB
通讯作者：
LIVINGSTON, RB
影响因子：
158.5
作者：
SCHAAKEKONING, C;VANDENBOGAERT, W;BARTELINK, H
通讯作者：
BARTELINK, H