关于老年非小细胞肺癌治疗的几点思考

Some Considerations on the Treatment of Elderly Non-small Cell Lung Cancer

目的:老年肺癌的发病在逐渐地增加,特别是非小细胞肺癌,但研究老年肺癌和接受治疗老年肺癌偏少,目前对老年肺癌的治疗多从回顾性研究得出的结论。老年肺癌手术治疗时,充分考虑到患者的术前功能状态尤其是心肺功能状态和合并症,微创的手术老年患者更合适。对于老年患者器官储备功能的降低和合并症多,对化疗的耐受能力降低,化疗能否给患者带来生存好处,采取单药还是双药化疗是临床讨论的问题还需要进一步研究。老年容易发生放射行肺炎和放射行食管炎,放疗时老年患者具有与年轻人不同的耐受量和体积当接受。对老年周围性肺癌放疗取得良好效果,对老年中央型肺癌采用调强或适形放疗多野放疗会增加了放射行肺炎的可能性,是否带来生存好处还没有被证实。靶向治疗药物的毒副反应较小,但其费用高反应率低,仅少数患者能够得到治疗好处。对于咳血症状比较明显的,可采用介入治疗。总之,对老年非小细胞肺癌患者治疗前需要进行全面的老年评估,还需要更多研究。

The incidence of lung cancer of geriatric cohort was increasing, especial in non-small cell lung cancer. However,the research on lung cancer in elderly patients was relatively rare, the same was the treatment on the cohort patients. The conclusion on lung cancer treatment in elderly patients often stem from retrospective analysis. The functional states of preoperation,especially in combination and cardiopulmonary function, should be carefully considered. The microinvasive surgical techniques may be better for the elderly patients. The elderly patients often couldn＇t bear to chemotherapy because of badly saving function and more combination. Questions need to be answered on advantage of chemo- therapy and choice for single-chemotherapy or doublet. There were more radiation pneumonia and radiation esophagitis for elderly patients compared with younger patients. The research on bearing volume and dose of lung on radiation in elderly patients was less than that in younger patients. The peripheral lung caner could achieve a better result on radiation. The advantage in central lung cancer patients was not identified whose radiation went through conformal or imaging modification radiation therapy, however, the radiation pneumonia maybe increase. The target therapy for elderly patients had less side-effect but with expensive cost and only few patients could get benefit. The interventional chemotherapy might be better when patient spat blood. In conclusion, Elderly patients with non-small cell lung cancer should be com- prehensively assessed before treatment. There should be more researches on the elderly lung cancer.