阳光肺科

 找回密码
 立即注册

微信扫码登录

搜索

[综合] Ⅰ期非小细胞肺癌的诊断和治疗管理Ⓜ️

[复制链接]
阳光肺科 发表于 2024-7-8 22:42:06 | 显示全部楼层 |阅读模式
肺癌外科手术标准:肺癌手术应做到完全性切除。
(一)完全性切除
  • 切缘阴性,包括支气管、动脉、静脉、支气管周围、肿瘤附近组织。
  • 淋巴结至少 6 组,其中肺内 3 组;纵隔 3 组(必须包括 7 区)。
  • 切除的最高淋巴结镜下阴性。
  • 淋巴结无结外侵犯。
(二)不完全性切除
  • 切缘肿瘤残留。
  • 胸腔积液或心包积液癌细胞阳性。
  • 淋巴结结外侵犯。
  • 淋巴结阳性但不能切除。
(三)不确定切除:切缘镜下阴性,但出现下列情况之一者
  • 淋巴结清扫未达要求。
  • 切除的最高纵隔淋巴结阳性。
  • 支气管切缘为原位癌。
  • 胸腔冲洗液细胞学阳性。

先进放疗技术
  • 包括 4D-CT 和 / 或 PET/CT 定位系统、VMAT(容积旋转调强放射治疗技术)、IGRT(影像引导放射治疗)、呼吸运动控制、质子治疗等。

辅助化疗
  • ⅠA 期非小细胞肺癌不建议辅助化疗,ⅠB 期非小细胞肺癌(包括有高危因素的肺癌),由于缺乏高级别证据的支持,常规不推荐辅助化疗。

不完全切除患者
  • 二次手术 ± 化疗(2A 类)或术后三维适形放疗 ± 化疗[ⅠB 期(2A 类),ⅠA 期(2B 类)]。

五、肺部病灶切除范围
  • 日本Ⅱ期临床研究 JCOG0804/WJOG4507L 显示,肿瘤实性成分比值(CTR) ≤ 0.25 且病灶数目≤ 3 个、长径≤ 2cm 的周围型 N0 肺癌,足够切缘的亚肺叶切除可提供很好的局部控制和 RFS,期待该研究更详细的数据。
  • JCOG0802 是一项多中心、开放、随机对照、非劣效Ⅲ期临床研究,旨在比较肺段切除和肺叶切除在 IA 期[肿瘤实性成分比值(CTR) > 0.5;肿瘤长径≤ 2cm]NSCLC 中的疗效与安全性。研究结果显示:肺段切除组和肺叶切除组相比,5 年 OS 率更高,分别为 94.3% 和 91.1%(HR=0.663,P < 0.001)。 5 年无复发生存时间,两组相当(肺段切除组:88% vs. 肺叶切除组:87.9%,HR=0.998,P=0.988 9)。
  • CALGB140503 比较了在 T1aN0(肿瘤直径 ≤ 2cm)NSCLC 中肺叶切除和亚肺叶切除(解剖性肺段切除或楔形切除) 的疗效。研究结果显示:亚肺叶切除组的无疾病生存期非劣效于肺叶切除组(HR=1.01;95% CI 0.83~1.24)。两组患者 5 年生存率差异无统计学意义(亚肺叶切除组:80.3% vs. 肺叶切除组:78.9%,95% CI 0.72~1.26)。胸腔镜下解剖学肺段切除或楔形切除(限 T1N0(≤ 2cm) 及肺野外 1/3 病灶)作为Ⅱ级推荐。


Ⅰ期非小细胞肺癌的诊断和治疗管理


参考文献:
  • 中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会 (CSCO) 非小细胞肺癌诊疗指南2024.人民卫生出版社.北京 2024


[1] SAJI H, OKADA M, TSUBOI M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399 (10335): 1607-1617.
[2] ALTORKI N, WANG X, KOZONO D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388 (6): 489-498.
[3] GRILLS IS, MANGONA VS, WELSH R, et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage Ⅰnon-small-cell lung cancer. J Clin Oncol, 2010, 28 (6): 928-935.
[4] TIMMERMAN R, PAULUS R, GALVIN J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA, 2010, 303 (11): 1070-1076.
[5] PALMA D, VISSER O, LAGERWAARD FJ, et al. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage Ⅰnon-small-cell lung cancer: A population-based time-trend analysis. J Clin Oncol, 2010, 28 (35): 5153-5159.
[6] CHANG JY, LIN SH, DONG W, et al. Stereotactic ablative radiotherapy with or without immunotherapy for early- stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer: An open-label, randomised, phase 2 trial. Lancet, 2023, 402 (10405): 871-881.
[7] ARRIAGADA R, BERGMAN B, DUNANT, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med, 2004, 350 (4): 351-360.
[8] ZHOU C, HE J, SU C, et al. Icotinib versus chemotherapy as adjuvant treatment for stage Ⅱ-ⅢA EGFR-mutant NSCLC (EVIDENCE): A randomized, open-label, phase 3 study. J Thorac Oncol, 2021, 16 (3): S232-S232.
[9] WU YL, TSUBOI M, HE J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med, 2020, 383 (18): 1711-1723.
[10] FELIP E, ALTORKI N, ZHOU CC, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage ⅠB-ⅢA non-small-cell lung cancer (IMpower010): A randomised, multicentre, open-label, phase 3 trial. Lancet, 2021, 398 (10308): 1344-1357.
[11] FORDE PM, SPICER J, LU S, et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med, 2022, 386 (21): 1973-1985.
[12] O′BRIEN M, PAZ-ARES L, MARREAUD S, et al. Pembrolizumab versus placebo as adjuvant therapy for com- pletely resected stage ⅠB-ⅢA non-small-cell lung cancer (PEARLS/KEYNOTE-091): An interim analysis of a ran- domised, triple-blind, phase 3 trial. Lancet Oncol, 2022, 23 (10): 1274-1286.
[13] WAKELEE H, LIBERMAN M, KATO T, et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N Engl J Med, 2023, 389 (6): 491-503.
[14] YUE D,WANG W, LIU H, et al. LBA58 Pathological response to neoadjuvant tislelizumab (TIS) plus platinum- doublet (PtDb) chemotherapy (CT) in resectable stage Ⅱ-ⅢA NSCLC patients (pts) in the phase Ⅲ (Ph3) RATIO- NALE-315 trial. Ann Oncol, 2023, 34: S1299.
[15] SOLOMON BJ, AHN JS, DZIADZIUSZKO R, et al. LBA2 ALINA: Efficacy and safety of adjuvant alectinib ver- sus chemotherapy in patients with early-stage ALK+ non-small cell lung cancer (NSCLC). Ann Oncol, 2023, 34: S1295-S1296.
[16] HEYMACH J V, MITSUDOMI T, HARPOLE D, et al. Design and rationale for a phase Ⅲ, double-blind, placebo- controlled study of neoadjuvant durvalumab + chemotherapy followed by adjuvant durvalumab for the treatment of patients with resectable stages Ⅱ and Ⅲ non-small-cell lung cancer: The AEGEAN trial. Clin Lung Cancer, 2022, 23 (3): e247-e251.
[17] O’ROURKE N, ROQUÉ I FIGULS M, FARRÉ BERNADÓ N, et al. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev, 2010, 16 (6): CD002140.
[18] CURRAN WJ, PAULUS R, LANGER CJ, et al. Sequential vs. concurrent chemoradiation for stage Ⅲ non-small cell lung cancer: Randomized phase Ⅲ trial RTOG 9410. J Natl Cancer Inst, 2011, 103 (19): 1452-1460.
[19] ALBAIN KS, CROWLEY JJ, TURRISI AT, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in patho- logic stage ⅢB non-small-cell lung cancer: A Southwest Oncology Group phase Ⅰ study, SWOG 9019. J Clin Oncol, 2002, 20 (16): 3454-3360.
[20] ZHAO J, ZHAO L, GUO W, et al. Efficacy, safety, and biomarker analysis of neoadjuvant camrelizumab and apa- tinib in patients with resectable non-small-cell lung cancer: A phase 2 clinical trial. J Thorac Oncol, 2023: S1556- 0864 (23): 161-162.

微信扫二维码转发分享

您需要登录后才可以回帖 登录 | 立即注册

本版积分规则

给我们建议|手机版|阳光肺科 ( 粤ICP备2020077405号-1 )

GMT+8, 2025-7-9 18:56

Powered by Discuz! X3.5

© 2001-2025 Discuz! Team.

快速回复 返回顶部 返回列表