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。     

局部晚期非小细胞肺癌的放疗进展

占肺癌80%的非小细胞肺癌(NSCLC)确诊时,能手术者仅占20%～30%,局部晚期者约为30%～40%,有区域和远处转移者占40%。约64.3%的NSCLC需放疗。因此,放疗在局部晚期NSCLC治疗中占有非常重要的位置。一、一般情况好的不能手术的局部晚期NSCLC不能手术的Ⅲ期NSCLC,为大淋巴结转移病灶(大N2     

局部晚期非小细胞肺癌预后因素评估

目的分析影响局部晚期非小细胞肺癌（NSCLC）3年生存率的预后因素。方法回顾性队列分析104例局部晚期NSCLC的病例资料；采用Kaplan—Meier方法分析单因素对生存率的影响，Log—rank检验比较生存率间的差异；多因素分析采用Cox比例风险模型。结果Kaplan-Meier方法单因素分析结果显示，14个预后相关因素中，Karnofsky评分（KPS评分）、体重减轻、临床分期、癌灶数目、N分期、细胞分化、治疗手段等7个因素对局部晚期NSCLC患者3年生存率有明显影响，经Log-rank检验，P〈0．05。在Cox比例风险模型分析结果中，KPS评分与临床分期2个因素对3年生存率影响显著，P〈0．01。结论KPS评分、体重减轻、临床分期、癌灶数目、N分期、细胞分化、治疗手段等7个因素对局部晚期NSCLC患者生存率有影响，而KPS评分、临床分期可作为独立因素对局部晚期NSCLC患者生存率产生影响。     

非小细胞肺癌治疗现状及进展

非小细胞肺癌 (ＮＳＣＬＣ)约占全部肺癌的 80 % ,为肺癌中最常见的类型。ＮＳＣＬＣ有多种类型 ,其中以鳞型、腺型为主 ,其生物学行为、发展、分子生物学、药物敏感性、预后等相似之处较多 ,但仍存在各自特点[1] 。故在决定治疗方案时 ,就有着不同的要求。1　ＮＳＣＬＣ的临床生物学特点1.1　ＮＳＣＬＣ的恶性程度较低 ,局部发展慢 ,但存在微转移灶的可能 ,而这是治疗成败的焦点。ＮＳＣＬＣ的生长速度较小细胞肺癌 (ＳＣＬＣ)慢 ,其倍增时间 (ＴＤ)在鳞癌、腺癌中分别为 92天和 168天。然而倍增时间是根据Ｘ线中肺部原发灶计算的 ,而ＮＳ…     

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，     

非小细胞肺癌新药化疗进展

非小细胞肺癌 ( NSCLC)约占全部肺癌的 80 % ,为肺癌中最常见的类型 ,其对化疗的敏感性远不如SCLC。铂类药物的出现使化疗疗效有较明显的提高。 2 0世纪 90年代以后 ,新的有效药物不断开发 ,如紫杉醇类、喜树碱类及嘧啶类抗代谢药等 ,其药理机制均针对 NSCLC的固有和获得性耐药 ,对NSCLC的疗效引起人们的极大兴趣 ,现综述如下。1　 NSCLC化疗新药1 .1　盐酸吉西他滨 ( gemcitabine,Gemzar,GTB)即盐酸双氟脱氧胞苷 ,商品名健择 (礼来公司 ) ,是嘧啶类抗代谢药物。主要作用于 DNA合成期 ( S期 ) ,也可阻止 G1期向 S期进展 ,是细…     

康莱特注射液联合化疗治疗晚期非小细胞肺癌

目的　比较康莱特注射液 +化疗组与单纯化疗组对IIIb -IV期初治非小细胞肺癌 (NSCLC)患者的近期疗效 ,临床受益疗效及毒性情况。方法　治疗组 34例 ,康莱特 2 0 0ml,静滴 ,第 1～ 2 0天。其中联合MVP方案化疗 2 4例 (MMC 6mg/m2 静注 ,第 1天 :VDS 3mg/m2 静注第 1,8天 :DDP 30mg/m2 ,静滴 ,第 2～ 4天 ) ;联合NP方案化疗 10例 :NVB 35mg/m2 ,静滴 ,第 1,8天 :DDP 30mg/m2 ,静滴 ,第 2～ 4天。对照组 30例 :MVP方案化疗者 2 0例 ,NP方案化疗者 10例 ,用法同前。两组均以每 3周为一周期 ,重复 2个周期。客观疗效与毒性反应按WHO标准来评价 ,临床受益疗效按行为状态评分及体重变化来评价。结果　两组有效率(CR +PR)分别为 35 2 9%和 2 6 6 7% (P >0 0 5 )。行为状态及体重变化 (临床受益疗效 )阳性率治疗组均明显高于对照组 (P <0 0 5 )。治疗组的血液毒性及消化系统毒性均低于对照组 (P <0 0 5 )。结论　康莱特注射液联合化疗治疗晚期非小细胞肺癌有较好的疗效 ,且毒副反应明显低于单纯化疗组 ,患者生活质量改善明显。     

局部晚期非小细胞肺癌治疗策略的新进展

对局部晚期肺癌的治疗不仅要考虑到局部,更要兼顾到全身,任何一种单一治疗(如单手术、化疗、放疗)均不可能有效地提高患者的长期生存率,只有采用多学科治疗,才有可能取得较好的治疗效果。本文就近年,尤以2007年以来最新的肺癌多学科治疗治疗策略作以综述。     

NP方案治疗晚期非小细胞肺癌40例临床观察

我科于 2 0 0 2年 1月至 2 0 0 3年 6月 ,采用连云港豪森制药厂生产的盖诺 (酒石酸长春瑞滨 ,NVB)联合顺铂 (DDP)治疗ⅢB～Ⅳ期非小细胞肺癌 (NSCLC) 40例 ,现将结果报告如下。材料与方法　患者中男 3 1例 ,女 9例 ;年龄 2 9～ 70岁 ,平均年龄 49岁 ,全部病例均经病理或细胞学证实为NSCLC。ⅢB期 2 6例 ,Ⅳ期 14例 ,初治 2 5例 ,复治15例 ,其中腺癌 2 2例 ,鳞癌 17例 ,腺鳞癌1例。Karnofsky评分≥ 60分以上 ,心、肝、肾功能及血象均正常 ,预计生存期 >3个月 ,有可测量的临床观察指标。给药方法为NVB 2 5mg/m2 加入生理盐水 40ml静…     

局部晚期非小细胞肺癌治疗的争议与共识

肺癌是发病率和死亡率增长最快，对人类健康和生命威胁最大的恶性肿瘤。完全性切除是目前治疗肺癌的最好方法。但是，仅有约1／3的肺癌适合于外科治疗，另2／3的肺癌由于伴有远处转移或侵犯邻近器官而被视为不可手术。近年来，随着心血管外科理论和技术在肺癌外科中的应用．使得肺切除合并受侵的左心房、胸主动脉、上腔静脉和肺动脉的整块切除成为可能。这些过去被视为外科禁忌证和无治愈希望的局部晚期肺癌，不但获得肿瘤完全切除、无肿瘤复发转移，而且获得长期生存和良好的生活质量。     

New strategies in the treatment of resectable non-small cell lung cancer

Non-small cell lung cancer is a systemic illness. Given the systemic nature of lung cancer, it seems that chemotherapy should play an essential role. In stage IIIA disease neoadjuvant chemotherapy plus surgical resection improves survival when compared with surgical resection alone. However, randomized trials using postoperative adjuvant chemotherapy with ‘older’ drugs has shown no substantial improvement in survival. Since new chemotherapeutic agents may provide additional benefits, there are various studies incorporating new agents in the resectable disease treatment setting. One focus for ongoing research is to find better treatment approaches in earlier stages of disease. Some data suggest that induction chemotherapy in stage I–II is feasible and appears not to compromise surgery. Another promising more individual approach is to tailor chemotherapy according to the pattern of genetic variants or abnormalities found in DNA and/or RNA extracted from the bloodstream. Furthermore, at present many types of new agents are available for testing as ‘consolidation treatment’ following induction treatment, including, angiogenesis inhibitors, antibodies to growth factor receptors, gene therapy and vaccines.     

New strategies in the treatment of resectable non-small cell lung cancer

Non-small cell lung cancer is a systemic illness. Given the systemic nature of lung cancer, it seems that chemotherapy should play an essential role. In stage IIIA disease neoadjuvant chemotherapy plus surgical resection improves survival when compared with surgical resection alone. However, randomized trials using postoperative adjuvant chemotherapy with 'older' drugs has shown no substantial improvement in survival. Since new chemotherapeutic agents may provide additional benefits, there are various studies incorporating new agents in the resectable disease treatment setting. One focus for ongoing research is to find better treatment approaches in earlier stages of disease. Some data suggest that induction chemotherapy in stage I-II is feasible and appears not to compromise surgery. Another promising more individual approach is to tailor chemotherapy according to the pattern of genetic variants or abnormalities found in DNA and/or RNA extracted from the bloodstream. Furthermore, at present many types of new agents are available for testing as 'consolidation treatment' following induction treatment, including, angiogenesis inhibitors, antibodies to growth factor receptors, gene therapy and vaccines.     

同步放化疗加热疗治疗局部晚期非小细胞肺癌的疗效观察

目的观察同步放化疗加热疗治疗局部晚期非小细胞肺癌（NSCLC）的临床近期疗效和不良反应。方法将64例Ⅲ期非小细胞肺癌患者随机分成观察组和对照组,每组32例。观察组患者给予同步放化疗联合热疗,对照组患者给予同步放化疗。治疗结束后2—3个月复查胸部CT评价临床近期疗效和不良反应。结果观察组患者总有效率（90．6％）高于对照组（81．3％）,但差异无统计学意义（χ^2=0．474,P=0．237）。治疗过程中主要不良反应为放射性食管炎、放射性肺炎、白细胞减少、血红蛋白减少等,且多为Ⅰ～Ⅱ度,观察组患者的不良反应显著低于对照组,差异有统计学意义（P〈0．05）。结论热疗联合同步放化疗治疗局部晚期非小细胞肺癌近期疗效肯定,不良反应小,患者耐受性好。     

Adjuvant therapy in resectable non-small cell lung cancer

In order to improve the management of lung cancer at various stages, we analyzed results of treatment in 928 of 1024 patients who were registered at our Hospital Tumor Registry of 1952-1983 with a pathological diagnosis of TNM for carcinoma of the lung after pulmonary resection. The 5-year-survival rate was 43% in 928 patients excluded the cases who were lost follow-up or succumbed within post-operative 1 month. The 5-year-survival rate was 77% for the stage I, 54.7% for the stage II, 17% for the stage III and 4% for the stage IV. The 5-year-survival rate by therapeutic modality was as follows: 52% for the group with chemotherapy, 35% for the one without adjuvant therapies, 29% for the one with irradiation and 15% for the one with radiochemotherapy. Patients with adenocarcinoma who underwent curative surgery showed improvement of survival by postoperative chemotherapy. No increase in survival time was noticed in the irradiated group with N2.     

晚期非小细胞肺癌的维持治疗

目前晚期非小细胞肺癌（NSCLC）一线治疗标准是以铂类为基础的双药化疗.标准疗程化疗后当疾病处于控制状态时下一步处理存在着很大争议,维持治疗逐渐应用于晚期NSCLC的治疗中.晚期NSCLC维持治疗可分为继续维持治疗与换药维持治疗,目前多用于维持治疗的培美曲塞和厄洛替尼已被证实可提高总体生存率.     

晚期非小细胞肺癌治疗新进展

肺癌是全世界最常见的恶性肿瘤。据世界卫生组织1985年的统计数字显示,当年的肺癌新病例有89.6万例,占所有癌症的11.8%。近20年的追踪发现,每年的肺癌新病例以大约0.5%的速率在增长,目前肺癌已成为严重危害人类生命和健康的常见病。2005年7月3～7日在西班牙巴塞罗那举行的第十一届世界肺癌大会(11thWorldConferenceofLungCancer,WCLC)上,来自全球的专家就近年来对肺癌的病因、预防、诊断和治疗进行了广泛的交流和讨论。在此就晚期非小细胞肺癌(non smallcelllungcancer,NSCLC)治疗新进展的主要内容综述如下,供各位同行分享。NSCLC是…     

局部晚期非小细胞肺癌的综合治疗

综述近年来局部晚期非小细胞肺癌(NSCLC)放射治疗、化学治疗和放化疗综合治疗方面的临床研究进展.介绍放射治疗包括常规分割放疗、超分割放疗和三维适形放疗等的发展,不同化疗方案的疗效分析及对比,推荐较为合理的单纯化疗和放化疗结合的治疗方案及分子靶向药物治疗的进展.同期放化疗与序贯放化疗在局部控制率和生存率上的比较,显示了综合治疗的优势.     

Palliative treatment for advanced non-small cell lung cancer

It should go without saying that all patients with advanced NSCLC are entitled to the treatment and care described in this article. It is probably also true that in many countries where these patients are often elderly and socially disadvantaged, they may have very variable access to this treatment and care. There is reasonable research evidence that both chemotherapy and palliative radiotherapy are modestly effective in controlling symptoms and prolonging life for some patients, but with significant risks of unpleasant and sometimes life-threatening toxicity. For this large and important group of patients, however, there are a large number of unanswered questions about the best regimens to use, how best to select patients so that they get the greatest benefit, how to mitigate side effects, and how best to integrate all the available treatment options. There have been significantly more trials in chemotherapy, but we must not overlook the need for research into palliative radiotherapy and other supportive care measures. There is still plenty of scope for intelligent and coordinated research.     

Neoadjuvant treatment in locally advanced non-small cell lung cancer

Any neoadjuvant or preoperative treatment program that would increase survival in clinically advanced non-small cell lung cancer (NSCLC) patients would be of significant benefit. In addition to improving patient survival, the program should be associated with minimal toxicity and surgical mortality. The rationale for any preoperative program is that the ability to resect the advanced cancer will be enhanced and micrometastasis will be eradicated. We have analyzed 323 patients enrolled in various types of neoadjuvant and preoperative studies. Review of this data indicates that cisplatin containing regimens produce relatively high responder rates in locally advanced NSCLC patients, resectability rate can be increased by a neoadjuvant program and chemotherapeutic toxicity and operative mortality are not prohibitive. Survival data frequently includes T3N0-1 patients, but there does appear to be increased survival at 3 and 4 years. These studies remain experimental and continued analysis is necessary before they can be accepted as standard therapy for clinically advanced NSCLC cancer.