ⅢA期非小细胞肺癌术后治疗研究现状  

Current status for the treatment of postoperative Stage ⅢA non-small cell lung cancer

作　　者：岳金波[1] 王真真[2] 于金明[1] 

机构地区：[1]山东省肿瘤医院放疗四科,山东济南250117 [2]山东省医学科学院附属医院人事科,山东济南250062

出　　处：《中华肿瘤防治杂志》2013年第20期1614-1618,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省医药卫生科技发展计划(2011QZ022)

摘　　要：目的:总结国内外关于ⅢA(N2)期非小细胞肺癌(non small-cell lung cancer,NSCLC)术后治疗的研究现状,探讨ⅢA(N2)期NSCLC患者根治术后治疗的选择。方法:应用PubMed、西文生物医学期刊文献数据库及万方期刊全文数据库检索系统,以"ⅢA(N2)期非小细胞肺癌、术后、化疗和放疗"为关键词,联合检索1996-01-2012-10的相关文献。纳入标准:1)ⅢA(N2)期NSCLC;2)术后;3)化疗;4)放疗,去除新辅助化疗或新辅助放疗文献。根据纳入标准,符合分析的文献22篇。结果:前瞻性Ⅲ期临床试验和回顾性分析研究显示,ⅢA(N2)期NSCLC术后辅助放疗可提高局部控制率,延长生存期;一系列多中心前瞻性临床试验证明术后化疗对于ⅢA(N2)NSCLC患者明显获益;术后辅助同步放化疗目前缺乏高级别的多中心临床试验支持;术后放疗靶区各肿瘤中心存在分歧,但前瞻性临床试验的研究方案统一确定的靶区勾画能降低这种差异。结论:目前对于ⅢA(N2)期术后切缘阴性的NSCLC患者,应给予术后辅助化疗联合放疗,不推荐术后单纯放疗或同步放化疗。化疗和放疗的顺序多采用先化疗后放疗模式。术后放疗靶区仍存在争议,在新的放疗技术条件平台下,有必要开展对手术完全切除后的ⅢA(N2)期NSCLC患者进行术后放疗靶区相对统一规定的Ⅲ期研究试验以进一步明确术后放疗价值。OBJECTIVE：To summarize the current status of treatment and provide the optimal strategy for postoper ative Stage ⅢA（N2 ）non-small cell lung cancer（NSCLC）. METHODS： With PubMed, Foreign Medical Journal database and Wanfang database searching system, papers were searched using the keywords ＂Stage ⅢANSCLC, Postoperative, Chemotherapy,Radiotherapy＂ from January 1996 to October 2012. Retrieval criteria： Stage Ill A NSCLC; Postoperative; Chemotherapy;Radiotherapy. Papers with neoadjuvant chemotherapy or radiotherapy were eliminated. Twenty-two papers were included according to the Retrieval criteria. RESULTS： Postoperative radiotherapy：Increased randomized clinical trial and retrospectively studies showed postoperative radiotherapy played important role in stage ⅢA（N2 ）NSCLC; Postopera tive chemotherapy：a series of clinical trials demonstrated that patients with stage ⅢA（N2 ）NSCLC benefited from postop- erative chemotherapy significantly; Postoperative concurrent chemoraditherapy： few randomized clinical trials suggested patients with stage ⅢA（N2 ）NSCLC benefited from postoperative concurrent chemoradiotherapy; Target contour： varia tions exited in the target contour for patients with postoperative stage ⅢA（N2 ） NSCLC,but contouring protocol devel oped for clinical trial significantly decreased the variations. CONCLUSIONS： For patients with stage ⅢA（N2 ） NSCLC re ceiving complete operation,adjuvant chemotherapy is compulsory with high grade level evidence. Adjuvant radiotherapy isrecommended to combined with chemotherapy rather than concurrent chemoradiotherapy after complete surgery. For pa tients with stageⅢA（N2 ） NSCLC, Radiotherapy can be given after chemotherapy. Controversy exists in the target con- tour for patients with postoperative stage ⅢA（N2 ） NSCLC. Based on the modern advanced techniques and the same target contouring protocol, further randomized clinical trial is warranted to prove the value of operative radiotherapy.

关 键 词：ⅢA(N2)期非小细胞肺癌 术后 化疗 放疗 综述文献 

分 类 号：R734.2[医药卫生—肿瘤]