[The role of neoadjuvant therapy in the treatment of locally advanced, stage III non-small-cell lung cancer]. / A neoadjuváns terápia szerepe a lokálisan elôrehaladott, III. stádiumú nem kissejtes tüdôrákos betegek kezelésében.
Magy Onkol
; 49(2): 161-8, 2005.
Article
en Hu
| MEDLINE
| ID: mdl-16249813
OBJECTIVE: to review the progress achieved in the neoadjuvant treatment of patients with locally advanced NSCLC by evaluating the articles published during the last 10 years. METHOD: altogether 51 articles (including prospective and retrospective studies, and reviews) were analysed with the intention to evaluate the efficacy of the different neoadjuvant modalities. RESULTS: different types of neoadjuvant treatments were reported. The articles were heterogeneous not only in the aspect of the patient populations but also in regard to the treatment modalities and schedules, the mode and timing of combination of chemotherapy with radiotherapy. Most studies support the advantage of chemoradiotherapy. The chemotherapy should be platinum based, and combination with modern drugs as gemcitabine is recommended. Surgery provides the best local control of the disease. Lobectomy, and in special circumstances sleeve resection, are preferred. The best prognostic factors are the R0 resection and the downstaging of the mediastinal lymph nodes. The cause of death is usually progressive disease, often brain metastases. Because of frequent occurrence of brain metastases, preventive cranial irradiation is recommended by many authors. CONCLUSION: to be able to compare different treatment modalities with consistent patient groups, patients should be classified into well-defined subgroups. T4 tumours (except pleuritis carcinomatosa) behave as locoregional disease, N2/N3 tumours, however, resemble more to systemic diseases. With two- or three-modality treatment, 3-7% improvement can be achieved in the 5-year survival time of patients. Evaluating the results, the heterogeneity of stage III NSCLC should always be kept in mind. It is still unknown to which patients should surgery be offered after neoadjuvant therapy, and who will benefit more from chemoradiotherapy alone. Considering the downstaging effect of the therapy, the tumour and nodal state should be evaluated separately. To answer these questions, it is time to start large randomised studies.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neumonectomía
/
Carcinoma de Pulmón de Células no Pequeñas
/
Terapia Neoadyuvante
/
Neoplasias Pulmonares
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
Límite:
Humans
Idioma:
Hu
Revista:
Magy Onkol
Asunto de la revista:
NEOPLASIAS
Año:
2005
Tipo del documento:
Article
País de afiliación:
Hungria
Pais de publicación:
Hungria