RSS-Feed abonnieren
DOI: 10.1055/s-2004-829639
Multimodality Therapy in the Treatment of Lung Cancer
Publikationsverlauf
Publikationsdatum:
22. Juni 2004 (online)
![](https://www.thieme-connect.de/media/srccm/2004S1/lookinside/thumbnails/10.1055-s-2004-829639-1.jpg)
Lung cancer is the leading cause of cancer death in the world, causing more than one million deaths each year. The incidence and mortality rates are highest in the United States and Europe and continue to increase in developing nations. Non-small cell lung cancer (NSCLC) accounts for 80 to 85% of all new cases of lung cancer. The majority of patients with NSCLC present with advanced disease at the time of diagnosis. Although the prognosis of advanced NSCLC is very poor, current chemotherapy combinations have been shown to improve 1-year survival and quality of life for these patients. Approximately one third of patients with NSCLC are diagnosed with locally advanced disease. Although cure rates are modest and variable in locally advanced NSCLC, multimodality therapy (chemotherapy in combination with surgery or radiotherapy) has resulted in statistically significant improvement in 5-year survival when compared with surgery or radiotherapy alone. Patients with early-stage NSCLC have the best long-term survival rates following surgical resection; however, systemic recurrences remain a problem in the majority of these patients. The rationale for treating patients with early-stage NSCLC with combined-modality therapy (chemotherapy and surgery) is compelling, and several randomized trials are currently in progress. Although progress has been slow, when we consider the recent advances in smoking prevention, smoking cessation, staging classification, imaging and diagnostic techniques, screening and therapeutic modalities, and multidisciplinary care, as well as in the understanding of the molecular pathogenesis of lung cancer, the future, in my opinion, is very promising.
KEYWORDS
Non-small cell lung cancer (NSCLC) - advanced NSCLC - locally advanced NSCLC - early-stage NSCLC - preoperative chemotherapy - chemoradiotherapy in NSCLC
REFERENCES
- 1 Jemal A, Murray T, Samuels A et al.. Cancer statistics, 2003. CA Cancer J Clin. 2003; 53 5-26
- 2 Travis W D, Travis L B, Devesa S S. Lung cancer. Cancer. 1995; 75 191-202
- 3 Humphrey E W, Smart C R, Winchester D P et al.. National survey of the pattern of care for carcinoma of the lung. J Thorac Cardiovasc Surg. 1990; 100 837-843
- 4 World Health Organization .World health report, 1997: executive summary. Geneva; World Health Organization 1997: 1-13
- 5 Parkin D M, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin. 1999; 49 33-64
- 6 Wingo P A, Tong T, Bolden S. Cancer statistics, 1995. CA Cancer J Clin. 1995; 45 8-30
- 7 Non-small Cell Lung Cancer Collaborative Group . Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ. 1995; 311 899-909
- 8 Marino P, Pampallona S, Preatoni A et al.. Chemotherapy vs supportive care in advanced non-small-cell lung cancer: results of a meta-analysis of the literature. Chest. 1994; 106 861-865
- 9 Crinò L, Scagliotti G, Marangolo M et al.. Cisplatin-gemcitabine combination in non-small cell lung cancer (NSCLC): a phase II study [abstract 1066]. Proc Am Soc Clin Oncol. 1995; 14 352a
- 10 Langer C J, Leighton J C, Comis R L et al.. Paclitaxel and carboplatin in combination in the treatment of advanced non-small-cell lung cancer: a phase II toxicity, response, and survival analysis. J Clin Oncol. 1995; 13 1860-1870
- 11 Wozniak A J, Crowley J J, Balcerzak S P et al.. Randomized trial comparing cisplatin with cisplatin plus vinorelbine in the treatment of advanced non-small-cell lung cancer: a Southwest Oncology Group study. J Clin Oncol. 1998; 16 2459-2465
- 12 Schiller J H, Harrington D, Belani C P et al.. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002; 346 92-98
- 13 Cullen M H, Billingham L J, Woodroffe C M et al.. Mitomycin, ifosfamide, and cisplatin in unresectable non-small-cell lung cancer: effects on survival and quality of life. J Clin Oncol. 1999; 17 3188-3194
- 14 Ellis P A, Smith I E, Hardy J R et al.. Symptom relief with MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in advanced non-small-cell lung cancer. Br J Cancer. 1995; 71 366-370
- 15 Mountain C F, Dressler C M. Revisions in the international staging system for lung cancer. Chest. 1997; 111 1718-1723
- 16 Pearson F, DeLarue N C, Ilves R et al.. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg. 1982; 83 1-11
- 17 Martini N, Flehinger B J. The role of surgery in N2 lung cancer. Surg Clin North Am. 1987; 67 1037-1049
- 18 Depierre A, Milleron B, Moro-Sibilot D et al.. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIa non-small-cell lung cancer. J Clin Oncol. 2002; 20 247-253
- 19 Keller S M, Adak S, Wagner H et al.. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer. Eastern Cooperative Oncology Group. N Engl J Med. 2000; 343 1217-1222
- 20 Andre F, Grunenwald D, Pignon J P et al.. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol. 2000; 18 2981-2989
- 21 Wagner Jr H, Lad T, Piantadosi S et al.. Randomized phase 2 evaluation of preoperative radiation therapy and preoperative chemotherapy with mitomycin, vinblastine, and cisplatin in patients with technically unresectable stage IIIA and IIIB non-small cell cancer of the lung. LCSG 881. Chest. 1994; 106(suppl 6) S348-S354
- 22 Roth J A, Fossella F, Komaki R et al.. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994; 86 673-680
- 23 Rosell R, Gomez-Codina J, Camps C et al.. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med. 1994; 330 153-158
- 24 Elias A D, Herndon J, Kumar P et al.. A phase III comparison of “best local-regional therapy” with or without chemotherapy (CT) for stage IIIA T1-3N2 non-small cell lung cancer (NSCLC): preliminary results [abstract 1611]. Proc Am Soc Clin Oncol. 1997; 16 448a
- 25 Roth J A, Atkinson E N, Fossella F et al.. Long-term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. Lung Cancer. 1998; 21 1-6
- 26 Rosell R, Gomez-Codina J, Camps C et al.. Preresectional chemotherapy in stage IIIA non-small-cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung Cancer. 1999; 26 7-14
- 27 Yoneda S, Hibino S, Gotoh I et al.. A comparative trial on induction chemoradiotherapy followed by surgery (CRS) or immediate surgery (IS) for stage III non-small cell lung cancer (NSCLC) [abstract 1128]. Proc Am Soc Clin Oncol. 1995; 14 367a
- 28 Perez C A, Pajak T F, Rubin P et al.. Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy: report by the Radiation Therapy Oncology Group. Cancer. 1987; 59 1874-1881
- 29 Dillman R O, Herndon J, Seagren S L et al.. Improved survival in stage III non-small cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996; 88 1210-1215
- 30 Sause W, Kolesar P, Taylor IV S et al.. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest. 2000; 117 358-364
- 31 Pritchard R S, Anthony S P. Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer: a meta- analysis. Ann Intern Med. 1996; 125 723-729
- 32 Marino P, Preatoni A, Cantoni A. Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb non-small cell lung cancer: a meta-analysis. Cancer. 1995; 76 593-601
- 33 Furuse K, Fukuoka M, Kawahara M et al.. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol. 1999; 17 2692-2699
- 34 Curran W, Scott C, Langer C et al.. Phase III comparison of sequential vs. concurrent chemoradiation for patients with unresected stage III non-small cell lung cancer (NSCLC): initial report of Radiation Therapy Oncology Group (RTOG) 9410 [abstract 303]. Lung Cancer. 2000; 29(suppl 1)
- 35 Jeremic B, Shibamoto Y, Acimovic L. Hyperfractionated radiation therapy with or without concurrent low-dose daily carboplatin/etoposide for stage III non-small-cell lung cancer: a randomized study. J Clin Oncol. 1996; 14 1065-1070
- 36 Schaake-Konig C, van den Bogaert W, Dalesio O et al.. Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med. 1992; 326 524-530
- 37 Bulzebruck H, Bopp R, Drings P et al.. New aspects in the staging of lung cancer: prospective validation of the International Union Against Cancer TNM classification. Cancer. 1992; 70 1102-1110
- 38 Mountain C F. Revisions in the international system for staging lung cancer. Chest. 1990; 97 1045-1051
- 39 Inoue H, Sato M, Fujimura S et al.. Prognostic assessment of 1310 patients with non-small cell lung cancer who underwent complete resection from 1980 to 1993. J Thorac Cardiovasc Surg. 1998; 116 407-411
- 40 Hensing T A, Detterbeck F, Socinski M A. The role of induction therapy in the management of resectable non-small cell lung cancer. Cancer Control. 2000; 7 45-55
- 41 Non-small Cell Lung Cancer Collaborative Group . Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials. BMJ. 1995; 311 899-909
- 42 Tonato M. Final report of the Adjuvant Lung Project Italy (ALPI): an Italian/EORTC-LCG randomised trial of adjuvant chemotherapy in completely resected non-small cell lung cancer (NSCLC) [abstract 1157]. Proc Am Soc Clin Oncol. 2002; 21 290a
- 43 The International Adjuvant Lung Cancer Trial collaborative Group . Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. N Engl J Med. 2004; 350 351-360
- 44 Pisters K M, Ginsberg R J, Giroux D J et al.. Induction chemotherapy before surgery for early-stage lung cancer: a novel approach. J Thorac Cardiovasc Surg. 2000; 119 429-439
- 45 From the Centers for Disease Control and Prevention: declines in lung cancer rates-California, 1988-1997. JAMA. 2000; 284 3121-3122
- 46 Peto R, Darby S, Deo H et al.. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000; 321 323-329
- 47 Ferrara N. Molecular and biologic properties of vascular endothelial growth factor. J Mol Med. 1999; 77 527-543
- 48 Franklin W A, Veve R, Hirsch F R et al.. Epidermal growth factor receptor family in lung cancer and premalignancy. Semin Oncol. 2002; 29(suppl 4) S3-S14
- 49 Herbst R S, Langer C J. Epidermal growth factor receptors as a target for cancer treatment: the emerging role of IMC-C225 in the treatment of lung and head and neck cancers. Semin Oncol. 2002; 29(suppl 4) S27-S36
- 50 Ciardiello F, Caputo R, Bianco R et al.. Antitumor effect and potentiation of cytotoxic drugs activity in human cancer cells by ZD-1839 (Iressa), an epidermal growth factor receptor-selective tyrosine kinase inhibitor. Clin Cancer Res. 2000; 6 2053-2063
- 51 Perez-Soler R, Chachoua A, Huberman M et al.. A phase II trial of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor OSI-774, following platinum-based chemotherapy, in patients (pts) with advanced, EGFR-expressing, non-small cell lung cancer (NSCLC) [abstract 1235]. Proc Am Soc Clin Oncol. 2001; 20 310a
M. Patricia RiveraM.D. F.C.C.P.
University of North Carolina at Chapel Hill, Division of Pulmonary and Critical Care Medicine, CB# 7020
130 Mason Farm Rd., 4133 Bioinformatics Bldg.
Chapel Hill, NC 27599-7020
eMail: mprivera@med.unc.edu