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Surgical challenges in multimodal treatment of N2-stage IIIA non-small cell lung cancer.

N2-stage IIIA非小细胞肺癌多模式治疗的外科挑战。

  • 影响因子:0
  • DOI:10.1093/jjco/hyaa249
  • 作者列表:"Yamaguchi M","Nakagawa K","Suzuki K","Takamochi K","Ito H","Okami J","Aokage K","Shiono S","Yoshioka H","Aoki T","Tsutani Y","Okada M","Watanabe SI","Lung Cancer Surgical Study Group (LCSSG) of the Japan Clinical Oncology Group (JCOG).
  • 发表时间:2021-03-03
Abstract

:Locally advanced non-small cell lung cancer, especially mediastinal lymph node metastasis-positive stage IIIA-N2 cancer, is a heterogeneous disease state characterized by anatomically locally advanced disease with latent micrometastases. Thus, surgical resection or radiotherapy alone has historically failed to cure this disease. During the last three decades, persistent efforts have been made to develop a suitable treatment modality to overcome these problems using chemotherapy and/or radiotherapy with surgical resection. However, the role of surgical resection remains unclear, and the standard treatment for stage IIIA-N2 disease is concurrent chemoradiotherapy. In general, adjuvant chemotherapy is indicated for completely resected pathological stage IB disease or lymph node metastasis-positive pathological stage II or IIIA disease. Platinum-based doublet cytotoxic chemotherapy is currently the standard regimen. Additionally, post-operative radiotherapy might be indicated for post-operatively proven mediastinal lymph node metastasis; i.e. clinical N0-1 and pathological N2 disease. With the remarkable progression that has recently been made in the field of chemotherapy, such as advances in molecular targeting agents and immune checkpoint inhibitors, the basic policy of chemotherapy has been shifting to personalized treatment based on the individual patient's oncogene driver mutation status, immune status and other parameters. The same trend is being seen in the treatment of stage IIIA-N2 disease. We should consider the past and upcoming results of several clinical trials to optimize the coming era of personalized treatment.

摘要

: 局部晚期非小细胞肺癌,尤其是纵隔淋巴结转移阳性的IIIA-N2期癌,是一种异质性的疾病状态,其特征是解剖学上的局部晚期疾病,具有潜在的微转移。因此,单独的手术切除或放射治疗在历史上未能治愈这种疾病。在过去的三十年中,已经进行了持续的努力来开发合适的治疗模式,以通过手术切除使用化学疗法和/或放射疗法来克服这些问题。然而,手术切除的作用仍不清楚,IIIA-N2期疾病的标准治疗是同步放化疗。通常,辅助化疗适用于完全切除的病理IB期疾病或淋巴结转移阳性的病理II期或IIIA期疾病。基于铂的双重细胞毒性化疗是目前的标准方案。此外,术后放疗可能适用于术后证实的纵隔淋巴结转移;临床N0-1和病理N2病。随着近期化疗领域取得的显著进展,如分子靶向药物和免疫检查点抑制剂的进展,化疗的基本方针已经转向基于个体患者的癌基因驱动突变状态、免疫状态和其他参数的个性化治疗。在IIIA-N2期疾病的治疗中也看到同样的趋势。我们应该考虑过去和即将到来的几个临床试验的结果,以优化个性化治疗的时代。

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