Chemoradiation for locally advanced, unresectable NSCLC. New standard of care, emerging strategies.
Chemoradiation for locally advanced, unresectable NSCLC. New standard of care, emerging strategies.
复制标题
局部晚期、不可切除的非小细胞肺癌的放化疗。
作者：
G. Gordon;E. Vokes;B. R. Leigh;David R. Gandara;Hak Choy
局部晚期、不可切除的III期非小细胞肺癌（NSCLC）的最佳治疗方法在不断发展。总体生存的关键决定因素包括局部肿瘤控制和亚临床微转移性疾病的根除。从历史上看，标准放射治疗的中位生存期为7至10个月。在一项随机试验中，癌症和白血病B组（CALGB）确定了诱导顺铂（铂醇）和长春花碱化疗后放疗的优越性。其他研究表明，诱导化疗通过减少转移性疾病进展提高了生存率。三个独立的荟萃分析证实了以顺铂为基础的诱导化疗后放疗所提供的生存益处，并有助于将其建立为新的护理标准。其他研究人员也证实了同步放化疗或高分割放疗对局部肿瘤控制和生存的改善。最近，人们的注意力集中在放射剂量强度和使用更新的、高活性的化疗药物与同步或顺序放射治疗。这些新药，包括紫杉醇（Taxol）、多西紫杉醇（taxoere）、吉西他滨（Gemzar）、长春瑞滨（Navelbine）和伊立替康（Camptosar），增强了辐射细胞毒性，当以系统活性剂量给药时，还可以控制微转移性疾病。新型放化疗方案的I期和II期研究继续显示出令人鼓舞的结果，一些大型随机临床试验目前正在招募患者。
The optimal therapy for locally advanced, unresectable, stage III non-small-cell lung cancer (NSCLC) continues to evolve. The critical determinants of overall survival include local tumor control and the eradication of subclinical micrometastatic disease. Historically, standard radiation therapy resulted in a median survival of 7 to 10 months. In a randomized trial, the Cancer and Leukemia Group B (CALGB) established the superiority of induction cisplatin (Platinol) and vinblastine chemotherapy followed by radiation therapy. Additional studies revealed that induction chemotherapy improved survival rates by decreasing metastatic disease progression. Three independent meta-analyses confirmed the survival benefit afforded by cisplatin-based induction chemotherapy followed by radiotherapy, and helped to establish this as the new standard of care. Other investigators have demonstrated improvements in local tumor control and survival with either concurrent chemoradiotherapy or hyperfractionated radiotherapy. Most recently, attention has focused on radiation dose intensity and the utilization of newer, highly active chemotherapeutic agents with concurrent or sequential radiation therapy. These newer drugs, including paclitaxel (Taxol), docetaxel (Taxotere), gemcitabine (Gemzar), vinorelbine (Navelbine), and irinotecan (Camptosar), enhance radiation cytotoxicity and, when administered in systemically active dosages, may also control micrometastatic disease. Phase I and II studies of novel chemoradiation regimens continue to demonstrate encouraging results, and several large randomized clinical trials are currently enrolling patients.