非小细胞肺癌的治疗:40年回眸与七个进展点

The treatment for non-small cell lung cancer:Look back in 40 years and recent advance

早期,非小细胞肺癌术后5年生存率只有30%左右,肺癌化疗主要药物是盐酸氮芥和氧化氮芥,晚期非小细胞肺癌的1年生存率只有10%左右,放射治疗是用深部X线或60钴。现在,有七个进展点:①手术治疗进展包括:系统淋巴结清扫术,气管隆凸或血管重建术及支气管成形术,电视胸镜技术(VATS)以及某些特定条件下Ⅳ期非小细胞肺癌的手术治疗(例如周围型肺癌脑转移,如果两者都是单个病灶可以手术完全切除);②放射治疗进展,三维适形放疗(3DCRT)和调强适形放疗(IMRT)提高了疗效且减少对周围肺组织的损伤;③化学治疗的进步:第3代化疗新药与铂类药物结合可把总有效率提高至40%左右,化疗类别进一步分为:新辅助化疗,术后辅助化疗,姑息性化疗和补救性化疗,其中,辅助性化疗和姑息性化疗近年来已得到确认;④放射治疗与化疗结合是局部晚期非小细胞肺癌的治疗模式;⑤生物治疗的进步,EGFR-TKIs(Iressa或Tarceva)已分别在东方和西方作为非小细胞肺癌二线或三线治疗药物;⑥Avastin与化疗药物相结合的生物化疗在非鳞性非小细胞肺癌的治疗中开创了新模式;⑦中医药治疗非小细胞肺癌具有改善生活质量和延长生存期的作用。

The treatment of non - small cell lung cancer （NSCLC） was not initial 40 years ago. The concept for muhimodulaty combination treatment was still constructed. Periphyreal lung cancer operation treatment was lobectomy with lymph nodes sampling. The 5 -year survival rate of early stage NSCLC operation treatment was only about 30 percent. Chemotherapy agents in treatment of NSCLC were mainly Nitrogen mustart and Nitromin. 1 -year survival of advanced NSCLC had only 10 percent. Radiotherapy used deeply x - ray or ^60Co. At present, there mainly were several advance ： ①the progression in operation： systematic lymph nodes resection, reconstruction of airway carina or vascular reconstitution, VATS, and surgery treatment of IV stage NSCLC in some given conditions, such as single lesions of both brain and lung completely resection, respectively, with survival improvement significantly. ② the progression in radiotherapy： 3DCRT and IMRT could enhance response rate with decreasing radiation damage in the lung. ③ the progression in chemotherapy ： overall response rate of the 3rd generation chemotherapeutic agents accounting for about 40 percent. The categories including ： neoadjuvant chemotherapy, ad- juvant chemotherapy, palliative chemotherapy and salvage chemotherapy. Of them, recently, both palliative and adjuvant chemotherapy which may improve survival time have reached consensus. ④radiotherapy combination with chemotherapy ： radiotherapy plus chemotherapy （concurrent or sequential chemoradiotherapy ） being best option for local advanced NSCLC. ⑤ the progression in biotherapy： EGFR - TKIs （Iressa or Tarceva ） in treatment of metastatic advanced NSCLC serving as 2nd or 3rd line agents were emphasized in Eastheru and westheru countries, respectively. ⑥ the progression in bio - chemotherapy： chemotherapeutic agents combination with Avastin treating non -squamous NSCLS ⑦ the progression in traditional Chinese medicine： clearly, traditional Chinese medicine improving quality -life and prolonging survival.