Tendency of multidisciplinary cooperation in surgical treatment of lung cancer / 中国癌症杂志

ABSTRACT

With the progression of chemotherapy (CT)and radiotherapy (RT), multidisciplinary measures in surgical treatment of lung cancer has become a hot subject for research. The chairman of ASCO, Dr. Bunn, pointed out that all kinds of cancers should be treated with multidisciplinary methods. Neoadjuvant chemotherapy is standard for care of Ⅲa N 2 NSCLC in Europe and U.S.A., but a large randomized trial was needed to confirm this hypothesis. At the 2003 ASCO meeting, Dr. Le Chevalier reported the result of the randomized international adjuvant lung cancer trial for 1867 resected NSCLC. 2 and 5 yr survival rates, progression free survival (PFS) were superior for the adjuvant CT group. Shanghai Lung Cancer Team studied 211 cases of rescected NSCLC with multi variant cox analyses. The result shows post operation chemotherapy might be beneficial to survival. Besides, in the cases with ≥3 cycles of post operation CT have better survival rates than less cycles. Patients with stage Ⅲa NSCLC and clinical or pathologically confirmed N 2 nodes (pN 2) have a poor prognosis after surgery of RT. Surgical resection after induction CT or CT/RT yields encouraging results in phase Ⅱ trials, but its role is controversial. Dr. Albain reported 429 cases of resectable Ⅲa (pN 2)NSCLC divided into CT/RT/S and CT/RT groups. CT/RT followed by surgery yields superior MST, 3-year survival rates and PFS, but there were more non cancer deaths in CT/RT/S group. The benefit reported could prevent annually-7,000 deaths worldwide.