tailieunhanh - Difficult Decisions in Thoracic Surgery - part 3

kiểm soát thử nghiệm cung cấp cơ sở chứng cứ cho việc thực hành tổng quát của liệu pháp cảm ứng hiện nay một số hình thức cho tất cả các bệnh nhân với giai đoạn IIIA (N2) NSCLC được cho là ứng cử viên cắt bỏ | 92 . Meyerson and . Harpole Jr. controlled trials provide the evidentiary basis for the current generalized practice of induction therapy in some form for all patients with stage IIIA N2 NSCLC thought to be resection candidates recommendation grade A . Some evidence exists that patients who will still require pneumonectomy after induction therapy may be better served by definitive chemoradiotherapy recommendation grade B . Evidence for what should constitute induction therapy is much less robust. There have been no systematic studies of what chemotherapeutic agents produce the best outcomes when used in induction therapy and agent choice in any individual trial generally represents investigator and institutional bias as to preferred agents. The only overall theme in the majority of phase II and III is the inclusion of a platinum agent in the proscribed therapy which is based on historical studies of agents with activity against NSCLC recommendation grade C . As newer potentially less toxic agents are developed these should be studied systematically in comparison to current regimens using large multi-institutional trials. Specific evidence for inclusion of radiation therapy in induction regimens is sparse mostly based on the historical use of radiation as a primary mode of treatment for locally advanced lung cancer recommendation grade D . However an ongoing well-designed randomized controlled trial RTOG 0412 sWOG S0332 Induction therapy should be recommended for all patients with stage IIIA N2 NSCLC thought to be resection candidates level of evidence 1 recommendation grade A . Patients who will still require pneumonectomy after induction therapy may be better served by definitive chemoradiotherapy evidence level 1 to 2 recommendation grade B . A platinum-based agent in the standard systemic therapy against NSCLC evidence level 2 to 3 recommendation grade C . Inclusion of radiation therapy in induction regimens is common but has not been adequately studied .