Treatment of stage I and II non-small-cell lung cancer.
Treatment of stage I and II non-small-cell lung cancer.
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DOI：
10.1177/107327480100800403
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发表时间：
2001-07
期刊：
影响因子：
--
通讯作者：
W. Smythe
中科院分区：
文献类型：
--
作者：
W. Smythe
背景I期和II期非小细胞肺癌（NSCLC）患者的适当分期和治疗非常重要，因为该人群失去治愈机会的可能性大于晚期NSCLC患者。方法：回顾I期和II期NSCLC的治疗选择-手术、放疗和化疗，并讨论新的分期方式对患者生存的影响，包括改变NSCLC诊断和治疗中存在的提前期和临床病理分期偏倚。还作出了一些预测，关于如何在不久的将来，该标准可能会改变临床医生，并讨论了进一步改善治疗后生存率的方法。结果早期NSCLC患者应尽可能行手术切除。不能选择切除术的患者可以从放射治疗中获益。新辅助化疗的阳性结果导致正在进行的随机试验（Intergroup S9900），以比较单独手术与新辅助化疗加手术。结论：分期偏倚可能影响早期NSCLC的总体低生存率。然而，真正的阶段特异性生存率可能会改善与新的成像方式。未来的进展，包括封闭式经胸放射，热消融治疗技术，基因治疗，可能取代需要手术切除这些肿瘤，以实现局部控制。
BACKGROUND The appropriate staging and treatment of patients with stage I and II non-small-cell lung cancer (NSCLC) are important in that the potential for a lost curative opportunity in this population is greater than for those presenting with advanced NSCLC. METHODS Treatment options -- surgery, radiation therapy, and chemotherapy -- for stage I and II NSCLC are reviewed, and the impact of newer staging modalities on patient survival is discussed, including altering both the lead-time and clinicopathologic stage biases that exist in the diagnosis and treatment of NSCLC. Some predictions are also made regarding how that standard may change for clinicians in the near future, and methods for further improvements in posttreatment survival in this group are discussed. RESULTS Whenever possible, patients with early-stage NSCLC should be treated with surgical resection. Patients for whom resection is not an option may benefit from radiation as definitive therapy. Positive results with neoadjuvant chemotherapy have led to an ongoing randomized trial (Intergroup S9900) to compare surgery alone to neoadjuvant chemotherapy plus surgery. CONCLUSIONS Staging bias may affect the overall low survival of early-stage NSCLC. However, true stage-specific survival may improve with newer imaging modalities. Future advances, including closed transthoracic radiation, thermal ablative therapy techniques, and gene therapy, may supplant the need to surgically resect these tumors to achieve local control.