局限性晚期非小细胞肺癌手术治疗的共识和争论

局限性广泛期NSCLC手术预后较差,近年相关研究颇多,在发展过程中必然存在共识、也会有争论。共识:手术能否全部切除、T3胸壁侵犯者预后较中央型T3为好。T3伴否肺门淋巴结转移预后显然不同,纵隔淋巴结转移N2和预后密切相关,其中淋巴结转移数、部位、侵及淋巴结外膜和年生存率密切相关。术前诱导治疗可改善Ⅲ期长期年生存率,尚需扩大病例数及多中心随机研究,T4N3Ⅲb期NSCLC预后差,切除率低。争论:临床分期方法不同影响结果,如N2影像分期不如纵隔镜,但前者为无创伤性检查。术后放疗能降低复发,未见有益于生存。肺上沟瘤术前放疗并发症高。30％患者有胸内淋巴结跳站转移,手术时应切开纵隔仔细搜寻送检各站淋巴结。pN2作全肺切除死亡率高,不见得有益。隆突切除不适用于伴N1、N2患者。胸膜癌性积液原则上属非手术疾病。     

N2非小细胞肺癌治疗进展

肺癌是目前世界上最常见的恶性肿瘤之一 ,随着我国工业化速度的加快和吸烟率的增加 ,肺癌的发病率在我国城镇中正迅猛增长 ,已成为我国城市人口恶性肿瘤死亡原因的第一位[1] 。按世界人口调整率 ,2 0 0 0年我国肺癌男、女性发病率分别增长至 3 8.46× 10 -5和 15 .70× 10 -5,仅次于胃癌和肝癌 ,居我国恶性肿瘤的第三位。由于约 75 %的肺癌患者在发现时已属中晚期 ,目前肺癌的总 5年生存率约10 %。国内外众多作者报道N2 非小细胞肺癌 (N2 NSCLC)患者单纯手术后治疗效果不佳 ,其 5年生存率为 17.3 %～2 7.9% [2 ,3 ] 。N2 NSCLC完全性…     

非小细胞肺癌的手术治疗

我院自1960年至1983年24年间住院手术治疗非小细胞肺癌276例,其中鳞癌134例(48.6％),腺癌100例(36.2%)、大细胞癌20例(7.2%)、腺鳞癌3例(1.1％)和未定型癌19例(6.9%)。手术切除180例(包括6例死亡),切除率为65.2％。根治性切除163例中Ⅰ期114例(70％)、Ⅱ期42例(25.7％)和Ⅲ期7例(4.3％)。能评价疗效者157例,其5年生存率为42.5％,10年生存率29.4％。淋巴结无转移的5年生存率为47％,10年为35.4％;有转移的5年生存率为29.4%,10年为15％。Ⅰ期的5年生存率为48.4％,Ⅱ期为23.3％。不同病理类型的预后有较大区别,本组鳞癌的预后优于腺癌。癌瘤位于上叶或下叶对预后影响不明显,以中叶肺癌的预后为最差,手术标本支气管断端肉眼所见正常,但並微镜下见癌细胞者12例,半数术后良好,死于癌者亦未见残端复发癌。     

MAP治疗非小细胞肺癌的疗效分析

选取本院１９９０年２月～１９９２年２月经细胞学、组织学证实的非小细胞肺癌６３例，用ＭＡＰ方案治疗取得满意效果。其中腺型占６５．１％，鳞型及低分化型分别占２５．４％和９．５％。化疗后总有效率为３９．７％（２５／６３）均为ＰＲ，１例ＰＤ。Ⅱ、Ⅲ、Ⅳ期有效率分别为６０．０％、４２．４％和３２．０％；鳞型和腺型有效率分别为３７．５％和３４．２％，低分化型非小细胞癌最佳达８３．３％，Ｐ值均＞０．０５。副反应     

MVP和TVP治疗晚期非小细胞肺癌的前瞻随机研究

目的 评价MVP和TVP两种方案治疗晚期非小细胞肺癌的有效率、毒性和生存期。方法 66例晚期非小细胞肺痛随机分为两组，MVP组32例，TVP组34例，两组患者资料相似。MVP组：丝裂霉素(MMC)6～8mg／m^2，静注，第1天；长春花碱酰胺(VDS)2～3mg／m^2，静滴，第1、8天；顺铂(DDP)70～80mg／m^2，静滴，第1天或分两天。TVP组：吡喃阿霉素(THP)40～50mg／m^2，第1天，VDS和DDP同上。两方案均为一周期21天，每例完成2～4周期。结果 MVP组有效率为34％(完全缓解1例，部分缓解10例)，TVP组有效率为56％(完全缓解1例，部分缓解18例)，TVP有效率高于MVP组，但统计学无意义(X^2=2．269，P=0．132)。TVP组Ⅲ Ⅳ度骨髓抑制发生率高于MVP组，其中粒细胞抑制有显著性差异(79％与44％，X^2=7．458，P=0．006)。MVP组与TVP组的中位生存期分别为12个月与8个月，1年生存率53％与24％(X^2=4．943，P=0．026)，2年生存率17％与6％，3年生存率6％与0。结论 MVP有效率相对较低，但血液毒性低，患者生存期和牛存率高，是晚期非小细胞肺癌化疗的合适方案。TVP方案近期有效率高，但血液毒性明显，与MVP方案比较，没有明显的生存受益。     

非小细胞肺癌术后辅助化疗的共识

近年来有关非小细胞肺癌术后辅助化疗的治疗标准发生了显著变化,越来越多的前赡性、大样本随机临床试验和多项荟萃分析均证实辅助化疗,特别是新一代化疗药物的含铂联合方案能显著提高化疗反应和总体生存期,降低死亡危险比,且毒性反应均可耐受.因此,对于完整手术后的非小细胞肺癌,特别是Ⅰ B～Ⅱ期的患者采用辅助化疔是合理治疗方案.     

局部晚期非小细胞肺癌诊断治疗之共识

局部晚期非小细胞肺癌 (ｎｏｎ ｓｍａｌｌｃｅｌｌｌｕｎｇｃａｎｃｅｒ,ＮＳＣＬＣ)指的是已有纵隔淋巴结转移 (Ｎ2 )、或侵犯纵隔重要结构 (Ｔ4 )、或有锁骨上淋巴结转移 (Ｎ3)的肺癌。按照肺癌′97国际分期 ,局部晚期ＮＳＣＬＣ为ⅢＡ或ⅢＢ的肺癌。目前这部分ＮＳＣＬＣ的治疗效果并不令人满意 ,ⅢＡ期的 5年生存率为 15 %～ 2 3% ,ⅢＢ期仅为 6 %～ 7%。从治疗学的观点看 ,局部晚期ＮＳＣＬＣ可分为可切除和不可切除两大类。可切除的局部晚期ＮＳＣＬＣ为 :(1)一部分术前临床分期为Ⅰ、Ⅱ期 ,但术后病理发现有纵隔淋巴结转移的病例 ,…     

非小细胞肺癌化疗—放疗同步疗法的探讨

局部晚期非小细胞肺癌的化疗-放疗同步疗法(Con-current Chemoradiotherapy)是近年非小细胞肺癌治疗的重要进展之一.此疗法的策略思路是强化局部病灶控制的同时兼顾到全身转移微小病灶的治疗.临床前试验已证明:紫杉醇(Paclitaxl)和紫杉特尔(Docetaxel)等抗癌药具有放疗增敏作用,其机理很可能是把肿瘤细胞同步至细胞周期G2/M期,以利用放射治疗更有效地杀灭肿瘤细胞.在此,本人较系统地复习了第8届世界肺癌会议(都柏林,1997.8),第24届ASCO会议(洛杉矾,1998.5)和第5届中欧肺癌会议(布拉格,1998.9)有关此疗法的文献,作如下介绍.1 化疗与传统分割放疗相结合的化疗-放疗同步疗法1.1 美国学者Langer C等报道用泰素与卡铂组成的化疗方案与胸部传统分割放疗的同步疗法治疗局部晚期非小细胞肺癌.泰素(Taxol)175～225mg/m~2,3h,静脉滴注,第1天和第22天;卡铂(AUC=7.5),静脉滴注,第1天和第22天;G—CSF,5μg/kg/d,皮下注射.第2～15天和第23～26     

晚期非小细胞肺癌二线治疗的最新进展

肺癌患者的一线化疗总的缓解率不是很高，很多患者在化疗中或化疗后出现疾病进展。需进一步治疗。最近，对晚期NSCLC的二线化疗的临床研究显示,二线化疗不但可以提高患者的生存期，而且可以改善肿瘤相关症状和提高生活质量，且使患者对止痛药及姑息性放疗的需求减少。本文对最近晚期NSCLC的二线化疗的研究进行简要的总结。     

非小细胞肺癌综合治疗新进展

肺癌为高发肿瘤．其中80％为非小细胞肺癌(non-small cell lung cancer．NSCLC)。手术治疗是NSCLC的最佳治疗方法，早中期手术切除的NSCLCI年生存率ⅠA期为67％，ⅠB期57％，ⅡA期55％，ⅡB期39％，ⅢA期23％。但NSCLC被发现时，仅20％～30％的病例有手术指征，约65％～70％的病例为不适宜手术的Ⅲ、Ⅳ期患者。即使能够手术，     

表皮生长因子受体酪氨酸激酶抑制剂与非小细胞肺癌的治疗

 表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）是一类高效低毒的抗肿瘤分子靶向药物,因其独特的疗效和良好的耐受性在非小细胞肺癌（NSCLC）治疗中成为研究的热点,在NSCLC的一线、二线或三线的辅助治疗中均有一定地位。随着研究的深入细化,EGFR TKI的适应证不断扩大,术前新辅助治疗可能成为一种新的治疗模式。     

埃罗替尼在非小细胞肺癌治疗中的研究进展

埃罗替尼（erlotinib）是表皮生长因子受体（EGFR）酪氨酸激酶抑制剂，能与细胞内EGFR分子酪氨酸激酶结构域的ATP结合袋特异性结合，可逆性地抑制EGFR酪氨酸激酶活性，促使肿瘤细胞凋亡，抑制肿瘤细胞的增殖、侵袭、血管新生和转移。该药目前已成功用于晚期非小细胞肺癌（NSCLC）的治疗，可显著延长患者的生存时间和无进展生存时间，显著改善症状，改善患者生活质量。     

Immunotherapy in the treatment of non-small cell lung cancer

Advances in the understanding of the role of the immune system in tumor immunosurveillance have resulted in the recognition that tumors can evade immune destruction via the dysregulation of co-inhibitory or checkpoint signals. This has led to the development of a generation immunotherapeutic agents targeting the immune checkpoint pathway. Recent early phase studies of immune checkpoint modulators, such as CTLA-4, PD-1 and PD-L1 inhibitors in NSCLC have reported promising results with prolonged clinical responses and tolerable toxicity. This article provides an overview of co-stimulatory and inhibitory molecules that regulate the immune response to tumors, recent therapies that have been developed to exploit these interactions and the role of predictive biomarkers in treatment selection.     

Erlotinib in the treatment of non-small cell lung cancer

Inhibition of the epidermal growth factor receptor is one of the most promising novel therapeutic strategies to be used in the treatment of patients with non-small cell lung cancer. A number of compounds that target the epidermal growth factor receptor are in an advanced stage of clinical development including both antibodies directed against the receptor and small molecule inhibitors of epidermal growth factor receptor tyrosine kinase activity. This drug profile focuses on the development of erlotinib, an orally available inhibitor of epidermal growth factor receptor tyrosine kinase. Results of clinical trials are reviewed, two trials of erlotinib in combination, one with paclitaxel and carboplatin, the other with gemcitabine and cisplatin, and the National Cancer Institute of Canada--Clinical Trials Group BR21, the first study to demonstrate a survival benefit for this class of compound in non-small cell lung cancer. The future role of erlotinib in the management of patients with non-small cell lung cancer is also discussed.     

培美曲塞治疗非小细胞肺癌

培美曲塞是一种多靶点的新型叶酸代谢拮抗剂,它通过抑制胸苷酸合成酶、二氢叶酸还原酶和甘氨酰胺核苷酸甲酰转移酶破坏细胞内叶酸依赖性代谢过程干扰细胞复制,从而抑制肿瘤生长。目前有关培美曲塞治疗包括恶性胸膜间皮细胞瘤、非小细胞肺癌、乳腺癌、胰腺癌、胃肠道肿瘤、头颈部肿瘤等多种恶性肿瘤的临床研究均有报道,本文综述培美曲塞单药或多药联合治疗在非小细胞肺癌的临床研究。     

Advances in the treatment of non-small cell lung cancer

While there have been advances in the treatment of lung cancer, they have been marginal in comparison with recent advances in the chemotherapy and molecularly targeted treatment of breast cancer, colorectal cancer and genitourinary cancer. Lung cancer is an extremely difficult disease to treat, and to obtain positive results and to develop new standard treatment. The results of clinical trial on gefitinib and erlotinib suggest that the evaluation of molecular target drugs seems to be quite difficult in unselected patient population and may be different from cytotoxic drugs. We need to find out specific molecular biomarkers for each drug. With global studies in view, it will be essential to obtain even more significant results by sophisticated clinical trials in selected patient populations and contribute to improving the treatment outcome of lung cancer patients.     

Erlotinib in the treatment of non-small cell lung cancer

Inhibition of the epidermal growth factor receptor is one of the most promising novel therapeutic strategies to be used in the treatment of patients with non-small cell lung cancer. A number of compounds that target the epidermal growth factor receptor are in an advanced stage of clinical development including both antibodies directed against the receptor and small molecule inhibitors of epidermal growth factor receptor tyrosine kinase activity. This drug profile focuses on the development of erlotinib, an orally available inhibitor of epidermal growth factor receptor tyrosine kinase. Results of clinical trials are reviewed, two trials of erlotinib in combination, one with paclitaxel and carboplatin, the other with gemcitabine and cisplatin, and the National Cancer Institute of Canada – Clinical Trials Group BR21, the first study to demonstrate a survival benefit for this class of compound in non-small cell lung cancer. The future role of erlotinib in the management of patients with non-small cell lung cancer is also discussed.     

埃罗替尼在非小细胞肺癌治疗中的研究进展

埃罗替尼(erlotinib)是表皮生长因子受体(EGFR)酪氨酸激酶抑制剂,能与细胞内EGFR分子酪氨酸激酶结构域的ATP结合袋特异性结合,可逆性地抑制EGFR酪氨酸激酶活性,促使肿瘤细胞凋亡,抑制肿瘤细胞的增殖、侵袭、血管新生和转移。该药目前已成功用于晚期非小细胞肺癌(NSCLC)的治疗,可显著延长患者的生存时间和无进展生存时间,显著改善症状,改善患者生活质量。     

Antiangiogenic drugs in non-small cell lung cancer treatment

PURPOSE OF REVIEW: A promising therapeutic target is the vascular endothelial growth factor pathway - a key mediator of tumor angiogenesis - which is important in tumor growth, invasion, and metastasis. This review focuses on the available clinical data on drugs targeting the vascular endothelial growth factor - vascular endothelial growth factor receptor pathway in the treatment of non-small cell lung cancer. RECENT FINDINGS: The therapeutic value of inhibiting the vascular endothelial growth factor pathway has been demonstrated by using drugs that prevent vascular endothelial growth factor receptor binding and by using drugs that inhibit receptor activation. Two antiangiogenic drugs exemplify these mechanisms: bevacizumab (Avastin; Genentech, South San Francisco, California, USA), a humanized monoclonal antibody that acts by binding and neutralizing vascular endothelial growth factor; and ZD6474 (Zactima; AstraZeneca, Macclesfield, UK), a small-molecule inhibitor of vascular growth factor receptor and epidermal growth factor receptor tyrosine kinase activity. Recently, the first results of a large, phase III randomized clinical trial of bevacizumab in combination with platinum-based doublet chemotherapy have been reported in patients with nonsquamous non-small cell lung cancer. SUMMARY: The inhibition of tumor angiogenesis is a key therapeutic strategy that holds great promise for the advancement of metastatic lung cancer therapy. The combination of bevacizumab and conventional chemotherapy could offer a new therapeutic option in selected non-small cell lung cancer histotypes.