非小細胞肺癌手術後輔助性化學治療

Adjuvant Chemotherapy in Non-Small-Cell Lung Cancer

施穎銘(Ying-Ming Shih) ； 陳育民(Yuh-Min Chen)

《內科學誌》 20卷6期 (2009/12) Pp. 490-496

https://doi.org/10.6314/JIMT.2009.20(6).03

摘要

早期非小細胞肺癌的標準治療是手術切除，手術後化療主要目的是想降低開刀後常見的遠端轉移。傳統的化學治療第二代藥物組合副作用較大，病人通常無法完成預定的療程，又不能有效延長存活期，一度被認爲是不必要的治療。第三代的肺癌化療藥物如vinorelbine搭配cisplatin爲主的雙效療法(doublet)，不僅副作用減少，病人的耐受性增加，而且有效的延長病人的存活期五年達5%，建議作爲第2期及第3A期非小細胞肺癌病人，手術後常規實行的輔助性治療。這些病人如果腫瘤細胞ERCC1(excision repair cross-complementation group 1)表現陰性，手術後接受cisplatin爲主的化療才能延長生命；若腫瘤細胞ERCC1表現陽性，術後接受cisplatin爲主的化療無效。而第1A期的病人手術後不需要接受化療，第1B期的病人有數篇日本人的研究支持肺腺癌每天口服UFT持續治療兩年有好處，但歐美國家同樣病人使用cisplatin爲主的雙效療法則沒有正面效果，因此第1B期的病人還有爭議。

關鍵字

非小細胞肺癌 ； 輔助性化學治療

並列摘要

Surgery is the standard treatment of choice for patients with early stage non-small cell lung cancer (NSCLC). Adjuvant chemotherapy is thought to be rational for these patients because distant metastasis is the most common form of recurrences despite complete surgical resection. However, there are high toxicities and low compliance by former chemotherapeutic regimens. They fail to provide survival benefit compared with observation. Cisplatin combined with vinorelbine is well tolerated third generation chemotherapeutic agents. They demonstrates 5% improved survival over 5 years and is recommended for routine use in post-operative NSCLC patients with stages ⅡA, ⅡB, ⅢA diseases. Furthermore, adjuvant cisplatin-based chemotherapy prolongs survival significantly in patients with ERCC1-negative tumors, but not in those with ERCC1-positive tumors. Adjuvant chemotherapy is not recommended for patients with stage IA NSCLC but controversial among stage IB. Oral UFT has been reported to obtain survival benefit among Japanese patients with stage IB disease but these results have not been confirmed outside Japan.

並列關鍵字

Non-small cell lung cancer ； Adjuvant chemotherapy