医師用治療情報　非小細胞肺癌

2011年6月最新版（2011年7月更新）　この情報は主に医師やほかの医療従事者用です．
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内容一覧　　　 一般情報
細胞分類
病期情報
　　肺癌の改訂版国際病期分類体系
　　TNMの定義
治療選択概観
潜在ー非小細胞肺癌
０期ー非小細胞肺癌
Ⅰ期ー非小細胞肺癌
Ⅱ期ー非小細胞肺癌
ⅢA期ー非小細胞肺癌
　　　肺尖部胸壁浸潤肺癌
　　　胸壁浸潤肺癌
ⅢB期ー非小細胞肺癌
Ⅳ期ー非小細胞肺癌
再発ー非小細胞肺癌
薬剤名


一般情報

統計

米国、20１１年における肺癌（非小細胞と小細胞の合計）の推定新患者および死亡数は:[1]

新患者　221,130人、死亡数　156,940人。

予後因子

複数の研究が手術後の予後決定要因の特定し、さまざまな臨床病理学的要因の予後の重要性を得ています。不利な予後と相関がある .[6,14-17] 要因は次のとおりです。
  • 肺症状の存在。
  • 大きな腫瘍サイズ (> 3 cm)。
  • 非扁平上皮組織。
  • TNM 定義内の複数のリンパ節への転移。..[18-28]]
  • 血管への浸潤。.[15,29-31]

参考文献

  1. American Cancer Society.: Cancer Facts and Figures 2011. Atlanta, Ga: American Cancer Society, 2011. Also available online. Last accessed June 20, 2011. 
  2. Ries L, Eisner M, Kosary C, et al., eds.: Cancer Statistics Review, 1975-2002. Bethesda, Md: National Cancer Institute, 2005. Available online. Last accessed August 13, 2010. 
  3. Johnson BE: Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst 90 (18): 1335-45, 1998.  [PUBMED Abstract]
  4. Wingo PA, Ries LA, Giovino GA, et al.: Annual report to the nation on the status of cancer, 1973-1996, with a special section on lung cancer and tobacco smoking. J Natl Cancer Inst 91 (8): 675-90, 1999.  [PUBMED Abstract]
  5. Thomas P, Rubinstein L: Cancer recurrence after resection: T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 49 (2): 242-6; discussion 246-7, 1990.  [PUBMED Abstract]
  6. Martini N, Bains MS, Burt ME, et al.: Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 109 (1): 120-9, 1995.  [PUBMED Abstract]
  7. van Boxem AJ, Westerga J, Venmans BJ, et al.: Photodynamic therapy, Nd-YAG laser and electrocautery for treating early-stage intraluminal cancer: which to choose? Lung Cancer 31 (1): 31-6, 2001.  [PUBMED Abstract]
  8. Blumberg J, Block G: The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study in Finland. Nutr Rev 52 (7): 242-5, 1994.  [PUBMED Abstract]
  9. Omenn GS, Goodman GE, Thornquist MD, et al.: Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 334 (18): 1150-5, 1996.  [PUBMED Abstract]
  10. Lippman SM, Lee JJ, Karp DD, et al.: Randomized phase III intergroup trial of isotretinoin to prevent second primary tumors in stage I non-small-cell lung cancer. J Natl Cancer Inst 93 (8): 605-18, 2001.  [PUBMED Abstract]
  11. van Zandwijk N, Dalesio O, Pastorino U, et al.: EUROSCAN, a randomized trial of vitamin A and N-acetylcysteine in patients with head and neck cancer or lung cancer. For the EUropean Organization for Research and Treatment of Cancer Head and Neck and Lung Cancer Cooperative Groups. J Natl Cancer Inst 92 (12): 977-86, 2000.  [PUBMED Abstract]
  12. Bach PB, Silvestri GA, Hanger M, et al.: Screening for lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132 (3 Suppl): 69S-77S, 2007.  [PUBMED Abstract]
  13. Travis WD, Colby TV, Corrin B, et al.: Histological typing of lung and pleural tumours. 3rd ed. Berlin: Springer-Verlag, 1999. 
  14. Albain KS, Crowley JJ, LeBlanc M, et al.: Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 9 (9): 1618-26, 1991.  [PUBMED Abstract]
  15. Macchiarini P, Fontanini G, Hardin MJ, et al.: Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-small-cell lung cancer. J Thorac Cardiovasc Surg 106 (1): 80-9, 1993.  [PUBMED Abstract]
  16. Ichinose Y, Yano T, Asoh H, et al.: Prognostic factors obtained by a pathologic examination in completely resected non-small-cell lung cancer. An analysis in each pathologic stage. J Thorac Cardiovasc Surg 110 (3): 601-5, 1995.  [PUBMED Abstract]
  17. Fontanini G, Bigini D, Vignati S, et al.: Microvessel count predicts metastatic disease and survival in non-small cell lung cancer. J Pathol 177 (1): 57-63, 1995.  [PUBMED Abstract]
  18. Sayar A, Turna A, Kilicgun A, et al.: Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung. Eur J Cardiothorac Surg 25 (3): 434-8, 2004.  [PUBMED Abstract]
  19. Osaki T, Nagashima A, Yoshimatsu T, et al.: Survival and characteristics of lymph node involvement in patients with N1 non-small cell lung cancer. Lung Cancer 43 (2): 151-7, 2004.  [PUBMED Abstract]
  20. Ichinose Y, Kato H, Koike T, et al.: Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials. Lung Cancer 34 (1): 29-36, 2001.  [PUBMED Abstract]
  21. Tanaka F, Yanagihara K, Otake Y, et al.: Prognostic factors in patients with resected pathologic (p-) T1-2N1M0 non-small cell lung cancer (NSCLC). Eur J Cardiothorac Surg 19 (5): 555-61, 2001.  [PUBMED Abstract]
  22. Asamura H, Suzuki K, Kondo H, et al.: Where is the boundary between N1 and N2 stations in lung cancer? Ann Thorac Surg 70 (6): 1839-45; discussion 1845-6, 2000.  [PUBMED Abstract]
  23. Riquet M, Manac'h D, Le Pimpec-Barthes F, et al.: Prognostic significance of surgical-pathologic N1 disease in non-small cell carcinoma of the lung. Ann Thorac Surg 67 (6): 1572-6, 1999.  [PUBMED Abstract]
  24. van Velzen E, Snijder RJ, Brutel de la Riviere A, et al.: Lymph node type as a prognostic factor for survival in T2 N1 M0 non-small cell lung carcinoma. Ann Thorac Surg 63 (5): 1436-40, 1997.  [PUBMED Abstract]
  25. Vansteenkiste JF, De Leyn PR, Deneffe GJ, et al.: Survival and prognostic factors in resected N2 non-small cell lung cancer: a study of 140 cases. Leuven Lung Cancer Group. Ann Thorac Surg 63 (5): 1441-50, 1997.  [PUBMED Abstract]
  26. Izbicki JR, Passlick B, Karg O, et al.: Impact of radical systematic mediastinal lymphadenectomy on tumor staging in lung cancer. Ann Thorac Surg 59 (1): 209-14, 1995.  [PUBMED Abstract]
  27. Martini N, Burt ME, Bains MS, et al.: Survival after resection of stage II non-small cell lung cancer. Ann Thorac Surg 54 (3): 460-5; discussion 466, 1992.  [PUBMED Abstract]
  28. Naruke T, Goya T, Tsuchiya R, et al.: Prognosis and survival in resected lung carcinoma based on the new international staging system. J Thorac Cardiovasc Surg 96 (3): 440-7, 1988.  [PUBMED Abstract]
  29. Thomas P, Doddoli C, Thirion X, et al.: Stage I non-small cell lung cancer: a pragmatic approach to prognosis after complete resection. Ann Thorac Surg 73 (4): 1065-70, 2002.  [PUBMED Abstract]
  30. Macchiarini P, Fontanini G, Hardin MJ, et al.: Relation of neovascularisation to metastasis of non-small-cell lung cancer. Lancet 340 (8812): 145-6, 1992.  [PUBMED Abstract]
  31. Khan OA, Fitzgerald JJ, Field ML, et al.: Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung. Ann Thorac Surg 77 (4): 1173-8, 2004.  [PUBMED Abstract]
  32. Earle CC, Tsai JS, Gelber RD, et al.: Effectiveness of chemotherapy for advanced lung cancer in the elderly: instrumental variable and propensity analysis. J Clin Oncol 19 (4): 1064-70, 2001.  [PUBMED Abstract]

トップ


非小細胞肺癌の細胞分類

新WHO（世界保健機構：World Health Organization）／国際肺癌研究会議の非小細胞肺癌に対する組織学的分類

1.       扁平上皮癌　Squamous cell carcinoma。

  • 乳頭　Papillary。
  • 淡明細胞　Clear cell。
  • 小細胞　Small cell。
  • 類基底細胞　Basaloid。

2.       腺癌　Adenocarcinoma。

  • 腺房　Acinar。
  • 乳頭　Papillary。
  • 細気管支肺胞上皮癌　Bronchioloalveolar carcinoma。
    • 非粘液　Nonmucinous。
    • 粘液　Mucinous。
    • 粘液と非粘液の混合、または中間細胞型　Mixed mucinous and nonmucinous or indeterminate cell type。
  • 粘液充実腺癌　Solid adenocarcinoma with mucin。
  • 混合亜型を伴った腺癌　Adenocarcinoma with mixed subtypes。
  • 特殊型　Variants。
    • 高分化胎児型腺癌　Well-differentiated fetal adenocarcinoma。
    • 粘液（コロイド）腺癌　Mucinous (colloid) adenocarcinoma。
    • 粘液嚢胞腺癌　Mucinous cystadenocarcinoma。
    • 印鑑腺癌　Signet ring adenocarcinoma。
    • 淡明腺癌　Clear cell adenocarcinoma。

3.       大細胞癌　Large cell carcinoma。

  • 特殊型　Variants。
    • 大細胞神経内分泌癌　LCNEC　（Large-cell neuroendocrine carcinoma）。
    • 混合大細胞神経内分泌癌　Combined large-cell neuroendocrine carcinoma。
    • 類基底細胞癌　Basaloid carcinoma。
    • リンパ上皮腫様癌　Lymphoepithelioma-like carcinoma。
    • 淡明細胞癌　Clear cell carcinoma。
    • 桿状表現型を伴う大細胞癌　Large-cell carcinoma with rhabdoid phenotype。

4.       腺扁平上皮癌　Adenosquamous carcinoma。

5.       多形性、肉腫様、肉腫性成分を伴う癌　Carcinomas with pleomorphic, sarcomatoid or sarcomatous elements。

  • 紡錘細胞および／または巨細胞を伴う癌　Carcinomas with spindle and/or giant cells。
  • 紡錘細胞癌　Spindle cell carcinoma。
  • 巨細胞癌　Giant cell carcinoma。
  • 癌肉腫　Carcinosarcoma。
  • 肺芽腫　Pulmonary blastoma。

6.       カルチノイド腫瘍　Carcinoid tumor。

  • 定型カルチノイド　Typical carcinoid。
  • 非定型カルチノイド　Atypical carcinoid。

7.       唾液腺型の癌Carcinomas of salivary-gland type。

  • 粘類表皮癌　Mucoepidermoid carcinoma。
  • 腺様嚢胞癌　Adenoid cystic carcinoma。
  • その他　Others。

8.       分類不能癌Unclassified carcinoma。

参考文献

  1. Travis WD, Colby TV, Corrin B, et al.: Histological typing of lung and pleural tumours. 3rd ed. Berlin: Springer-Verlag, 1999. 

トップ


病期情報

病期を決定する過程には以下のものがあります：

  • 病歴
  • 身体診察
  • 標準臨床検査
  • 胸部X線検査
  • 造影剤を注入する胸部コンピュータ断層撮影（CT）スキャン。
  • FDG-PET検査

病理病期分類には以下が必要です：

  • 腫瘍の検査。
  • 切除断端。
  • リンパ節。

予後および治療の決定は以下の因子に基づきます：

  • 組織型。
  • 腫瘍の大きさと位置。
  • 胸膜浸潤。
  • 切除断端。
  • リンパ節の状態と位置。
  • 腫瘍の悪性度。
  • リンパ血管性浸潤。

肺癌の改訂国際病期分類体系

肺癌の改訂国際病期分類体系は、5,000人以上の患者の臨床データベースから得た情報に基づいて2010年、American Joint Committee on Cancer（AJCC）およびUnion Internationale Contre le Cancerによって採用されました。 [17] [18] これらの改訂は、患者の予後の特異性に重点をおいています。しかし、病期と予後の相関はPET検査が広く利用される以前のものです。

改訂の要約

この病期分類システムは現在、非小細胞肺癌NSCLCおよび小細胞肺癌の両方の分類および肺カルチノイドcarcinoidについて推奨されています。 [18]

T（原発腫瘍）の分類は以下のように再定義されている： [18]

  • T1は、T1a（大きさが2cm以下）およびT1b（大きさが2cm超-3cm）に亜分類されている。
  • T2は、T2a（大きさが3cm超-5cm）およびT2b（大きさが5cm超-7cm）に亜分類されている。
  • T2（大きさが7cm超）はT3に再分類されている。
  • 同一肺葉内における多発性腫瘍結節はT4～T3に再分類されている。
  • 同一肺内ではあるが異なる肺葉における多発性腫瘍結節はM1からT4に再分類されている。

N（所属リンパ節）分類については変更されていない。しかしながら、リンパ節の節について解剖学的境界を定義した新たな国際リンパ節マップが開発された。

M（遠隔転移）の分類は以下のように再定義されている：

  • M1はM1aおよびM1bに細分されている。
  • 悪性胸水および心嚢貯留液はT4からM1aに再分類されている。
  • 対側肺における異なる腫瘍結節はM1aと考えられる。
  • M1bは遠隔転移を意味する。
表 1. 6版と7版の病期グループ比較
第6版と第7版の記載、TとM、病期分類a、b
6版　T/M ７版　T/M N0  N1  N2  N3 
T1 (≦2cm) T1a IA IIA IIIA IIIB
T1 (＞2cm－3cm) T1b IA IIA IIIA IIIB
T2 (≦5cm) T2a IB IIA IIIA IIIB
T2 (＞5cmー7cm) T2b IIA IIB IIIA IIIB
T2 (＞7ｃｍ) T3 IIB IIIA IIIA IIIB
T3 浸潤 T3 IIB IIIA IIIA IIIB
T4 [同一肺葉腫瘤] T3 IIB IIIA IIIA IIIB
T4 [進展] T4 IIIA IIIA IIIB IIIB
M1 [同側肺] T4 IIIA IIIA IIIB IIIB
T4 [悪性胸水] M1a IV IV IV IV
M1 [対側肺] M1a IV IV IV IV
M1 [遠隔転移] M1b IV IV IV IV

T = 原発腫瘍；M = 遠隔転移；N0 = 所属リンパ節に転移なし；N1 = 同側気管支周囲および/または同側肺門リンパ節および肺内リンパ節転移（原発腫瘍によるこれらリンパ節への直接浸潤を含む）；N2 = 同側縦隔リンパ節転移および/または気管支分岐部のリンパ節転移；N3 = 対側縦隔、対側肺門、同側または対側斜角筋前、または鎖骨上窩リンパ節転移。

a太字のセルは、特にTNMカテゴリーについて第6版からの変更を示す。

b掲載許可Reprinted with permission from Goldstraw P, Crowley J, Chansky K, et al.: The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J. Thorac Oncol 2:706-14, 2007.


TNMの定義

AJCCは非小細胞肺癌non-small cell lung cancerを定義するためにTNM分類を指定している。 [18]

表 2. 原発腫瘍 (T)
TX 原発腫瘍の存在が判定できない、あるいは画像上または気管支鏡的には観察できないが喀痰または気管支洗浄液中に悪性細胞が存在することで腫瘍の存在が分かる。
T0 原発腫瘍を認めない。
Tis 上皮内癌Carcinoma in situ.
T1 腫瘍の最大径が3cm以下で、肺組織または臓側胸膜に囲まれており、気管支鏡的にがん浸潤が葉気管支より中枢に及ばないもの（すなわち、主気管支に及んでいない）。b
T1a 最大径が2cm以下の腫瘍。
T1b 最大径が2cm超であるが3cm以下の腫瘍。
T2 3cm超であるが7cm以下の腫瘍または以下の特徴のいずれかを有する腫瘍（これらの特徴を有するT2腫瘍は5cm以下であればT2aに分類される）：
腫瘍浸潤が主気管支に及ぶ。
気管分岐部より2cm以上離れているもの。
臓側胸膜に浸潤のあるもの（PL1またはPL2）。
肺門に及ぶ無気肺または閉塞性肺炎があるが一側肺全体に及ばないもの。
T2a 最大径が3cm超であるが5cm以下の腫瘍。
T2b 最大径が5cm超であるが7cm以下の腫瘍。
T3 7cm超の腫瘍または以下のいずれかに直接浸潤している腫瘍：
壁側胸膜（PL3）胸壁（上溝腫瘍（肺尖部胸壁浸潤癌）を含む）、横隔膜、横隔神経、縦隔胸膜、または壁側心膜。
主気管支に及ぶ腫瘍（気管分岐部から2cm未満の距離に及ぶbが、気管分岐部に浸潤のないもの）。
無気肺あるいは閉塞性肺炎が一肺全体に及ぶもの、または同一肺葉内に存在する離れた腫瘍結節。
T4 腫瘍の大きさにかかわらず、以下のいずれかに浸潤しているもの：
縦隔、心臓、大血管、気管、反回神経、食道、椎体、気管分岐部、または異なる同側肺葉内に存在する離れた腫瘍結節。

aAJCCによる掲載許可：Lung. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 253-70.

b大きさと無関係に浸潤が気管支壁内に限局している表層浸潤型の腫瘍がまれにあり、その場合、進展が主気管支に及ぶものでもT1aに分類する。

表 3. 所属リンパ節 (N)a

NX 所属リンパ節の評価が不可能。
N0 所属リンパ節に転移を認めない。
N1 同側気管支周囲および/または同側肺門リンパ節および原発腫瘍の直接浸潤を含む肺内リンパ節転移。
N2 同側縦隔リンパ節転移および/または気管支分岐部のリンパ節転移。
N3 対側縦隔、対側肺門、同側または対側斜角筋前、または鎖骨上窩リンパ節転移。

aAJCCの掲載許可：Lung. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual.7th ed. New York, NY: Springer, 2010, pp 253-70.

表 4. 遠隔転移 (M)a

M0 遠隔転移を認めない。
M1 遠隔転移あり。
M1a 対側肺葉内に存在する離れた腫瘍結節あるいは胸膜結節または悪性胸水（または心嚢液）を伴う腫瘍。b
M1b 遠隔転移あり。

aAJCCの掲載許可：Lung. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual.7th ed. New York, NY: Springer, 2010, pp 253-70.

b肺がんに伴う胸水（および心嚢液）のほとんどは腫瘍によるものである。しかしながら、少数の患者で複数回、胸水（および心嚢貯留液）の細胞病理学的検査を実施しても腫瘍細胞陰性となる場合があり、この場合、液は非血性かつ非滲出性である。これらの検体検査の結果や臨床結果により、胸水が腫瘍と関係ないと決定される場合は、胸水を病期決定の要素から除外し、患者をM0に分類すべきである。

表 5. 病期a

病期 T  N  M 
潜在がん TX N0 M0
0 Tis N0 M0
IA T1a N0 M0
T1b N0 M0
IB T2a N0 M0
IIA T2b N0 M0
T1a N1 M0
T1b N1 M0
T2a N1 M0
IIB T2b N1 M0
T3 N0 M0
IIIA T1a N2 M0
T1b N2 M0
T2a N2 M0
T2b N2 M0
T3 N1 M0
T3 N2 M0
T4 N0 M0
T4 N1 M0
IIIB T1a N3 M0
T1b N3 M0
T2a N3 M0
T2b N3 M0
T3 N3 M0
T4 N2 M0
T4 N3 M0
IV Any T Any N M1a
Any T Any N M1b

aAJCCの掲載許可：Lung. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual.7th ed. New York, NY: Springer, 2010, pp 253-70.

参考文献

  1. Pfister DG, Johnson DH, Azzoli CG, et al.: American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. J Clin Oncol 22 (2): 330-53, 2004.  [PUBMED Abstract]
  2. Albain KS, Crowley JJ, LeBlanc M, et al.: Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 9 (9): 1618-26, 1991.  [PUBMED Abstract]
  3. Ludwig MS, Goodman M, Miller DL, et al.: Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer. Chest 128 (3): 1545-50, 2005.  [PUBMED Abstract]
  4. Webb WR, Gatsonis C, Zerhouni EA, et al.: CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology 178 (3): 705-13, 1991.  [PUBMED Abstract]
  5. Toloza EM, Harpole L, McCrory DC: Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 123 (1 Suppl): 137S-146S, 2003.  [PUBMED Abstract]
  6. Gould MK, Kuschner WG, Rydzak CE, et al.: Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med 139 (11): 879-92, 2003.  [PUBMED Abstract]
  7. Dwamena BA, Sonnad SS, Angobaldo JO, et al.: Metastases from non-small cell lung cancer: mediastinal staging in the 1990s--meta-analytic comparison of PET and CT. Radiology 213 (2): 530-6, 1999.  [PUBMED Abstract]
  8. Ung YC, Maziak DE, Vanderveen JA, et al.: 18Fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer: a systematic review. J Natl Cancer Inst 99 (23): 1753-67, 2007.  [PUBMED Abstract]
  9. Dietlein M, Weber K, Gandjour A, et al.: Cost-effectiveness of FDG-PET for the management of potentially operable non-small cell lung cancer: priority for a PET-based strategy after nodal-negative CT results. Eur J Nucl Med 27 (11): 1598-609, 2000.  [PUBMED Abstract]
  10. Scott WJ, Shepherd J, Gambhir SS: Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: a decision analysis. Ann Thorac Surg 66 (6): 1876-83; discussion 1883-5, 1998.  [PUBMED Abstract]
  11. Gambhir SS, Hoh CK, Phelps ME, et al.: Decision tree sensitivity analysis for cost-effectiveness of FDG-PET in the staging and management of non-small-cell lung carcinoma. J Nucl Med 37 (9): 1428-36, 1996.  [PUBMED Abstract]
  12. van Tinteren H, Hoekstra OS, Smit EF, et al.: Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet 359 (9315): 1388-93, 2002.  [PUBMED Abstract]
  13. Viney RC, Boyer MJ, King MT, et al.: Randomized controlled trial of the role of positron emission tomography in the management of stage I and II non-small-cell lung cancer. J Clin Oncol 22 (12): 2357-62, 2004.  [PUBMED Abstract]
  14. Vansteenkiste JF, Stroobants SG, De Leyn PR, et al.: Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J Clin Oncol 16 (6): 2142-9, 1998.  [PUBMED Abstract]
  15. Roberts PF, Follette DM, von Haag D, et al.: Factors associated with false-positive staging of lung cancer by positron emission tomography. Ann Thorac Surg 70 (4): 1154-9; discussion 1159-60, 2000.  [PUBMED Abstract]
  16. Liewald F, Grosse S, Storck M, et al.: How useful is positron emission tomography for lymphnode staging in non-small-cell lung cancer? Thorac Cardiovasc Surg 48 (2): 93-6, 2000.  [PUBMED Abstract]
  17. Yokoi K, Kamiya N, Matsuguma H, et al.: Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI. Chest 115 (3): 714-9, 1999.  [PUBMED Abstract]
  18. Mountain CF: Revisions in the International System for Staging Lung Cancer. Chest 111 (6): 1710-7, 1997.  [PUBMED Abstract]
  19. Lung. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 253-70. 

トップ


非小細胞肺癌の治療選択の概観

非小細胞肺癌（NSCLC：non-small cell lung cancer ）においては、多くの限局性肺癌を除いて標準治療の結果は不良です。新たに非小細胞肺癌と診断された全ての患者は、新しい治療法を評価するための試験の潜在的候補者です。

手術は、この病気のための最も可能性のある治療の治療の選択肢です。
術後補助化学療法は切除した非小細胞肺癌患者に追加の利点があります。
放射線療法と化学療法を組み合わせは、少数の患者の完治と、多くの患者に一時的軽快を提供することができます。予防的全脳照射（PCI：Prophylactic cranial irradiation ）は脳転移の発生を低下させるかもしれませんが、生存期間延長の証拠はなく、予防的全脳照射（PCI）の生活の質への効果は不明です。 [1] [2] 進行期疾患の患者では、化学療法が生存期間中央値のわずかな改善をもたらしますが、全生存率は不良です。 [3] [4]

化学療法は疾患関連症状に短期改善をもたらします。いくつかの臨床試験で、化学療法の腫瘍関連症状および生活の質への影響を評価する試みが行われています。全体として、これらの研究は、化学療法が全生活の質に悪影響を及ぼすことなく腫瘍関連症状を制御できることを示唆しています。 [5] [6] しかし、化学療法の生活の質への影響については、さらなる研究を要します。一般に、体力（performance status パフォーマンスステータス）が良好で医学的に健康な高齢患者は、治療によってより年齢の低い患者と同じ利益を得ます。

非小細胞肺癌に対する標準治療の選択肢

病期 (TNM ) 標準治療の選択肢
潜在　非小細胞肺癌 外科療法
0期　非小細胞肺癌 外科療法
気管支内療法
I期　非小細胞肺癌 外科療法
放射線療法
II期　非小細胞肺癌 外科療法
術前化学療法
術後追加化学療法
放射線療法
IIIA期
非小細胞肺癌		 切除後または切除可能肺癌 外科療法
術前化学療法
術後追加化学療法
切除不能肺癌 放射線療法
化学放射線療法
肺尖部胸壁浸潤癌 放射線療法単独
放射線療法と外科療法
同時化学療法、 放射線療法と外科療法を伴う
外科療法単独 (選択した患者さん用)
胸壁浸潤肺癌 外科療法
外科療法と放射線療法
化学療法、 放射線療法 and/or 外科療法を伴う
IIIB期　非小細胞肺癌 異時または同時化学療法と放射線療法
化学療法、外科療法が続く (選ばれた患者さん用)
放射線療法単独
IV期　非小細胞肺癌 細胞障害性併用化学療法
併用化学療法化学療法、ベバシズマブ bevacizumabあるいはセツキシマブ cetuximabを伴う
上皮成長因子受容体チロシンキナーゼEGFR阻害剤(EGFR 変異患者さん用)
維持化学療法、最初の化学療法に続く
外照射放射線療法 (姑息治療用)
気管支内レーザー療法、 and/or腔内照射 (閉塞性病変用)
再発　非小細胞肺癌 放射線療法 (姑息治療用)
化学療法単独
外科療法 (単発脳転移で、特に選ばれた患者さん用)
レーザー療法または内部放射線療法 (気管支内病変用)
立体放射線外科療法 (特に選ばれた患者さん用)

現在評価段階にある分野は以下の通りです：

  • 局所治療（手術）の併用。
  • 領域治療（放射線療法）。
  • 全身治療（化学療法、免疫療法、標的薬物）。
  • より効果的な全身療法の開発。

参考文献

  1. Lester JF, MacBeth FR, Coles B: Prophylactic cranial irradiation for preventing brain metastases in patients undergoing radical treatment for non-small-cell lung cancer: a Cochrane Review. Int J Radiat Oncol Biol Phys 63 (3): 690-4, 2005.  [PUBMED Abstract]
  2. Pottgen C, Eberhardt W, Grannass A, et al.: Prophylactic cranial irradiation in operable stage IIIA non small-cell lung cancer treated with neoadjuvant chemoradiotherapy: results from a German multicenter randomized trial. J Clin Oncol 25 (31): 4987-92, 2007.  [PUBMED Abstract]
  3. Chemotherapy for non-small cell lung cancer. Non-small Cell Lung Cancer Collaborative Group. Cochrane Database Syst Rev (2): CD002139, 2000.  [PUBMED Abstract]
  4. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 311 (7010): 899-909, 1995.  [PUBMED Abstract]
  5. Spiro SG, Rudd RM, Souhami RL, et al.: Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life. Thorax 59 (10): 828-36, 2004.  [PUBMED Abstract]
  6. Clegg A, Scott DA, Hewitson P, et al.: Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review. Thorax 57 (1): 20-8, 2002.  [PUBMED Abstract]
  7. Curran WJ, Scott CB, Langer CJ, et al.: Long-term benefit is observed in a phase III comparison of sequential vs concurrent chemo-radiation for patients with unresected stage III nsclc: RTOG 9410. [Abstract] Proceedings of the American Society of Clinical Oncology 22: A-2499, 2003. 
  8. Fournel P, Robinet G, Thomas P, et al.: Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 Study. J Clin Oncol 23 (25): 5910-7, 2005.  [PUBMED Abstract]
  9. Zatloukal P, Petruzelka L, Zemanova M, et al.: Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 46 (1): 87-98, 2004.  [PUBMED Abstract]
  10. Rowell NP, O'rourke NP: Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev (4): CD002140, 2004.  [PUBMED Abstract]
  11. Cerfolio RJ, Bryant AS, Winokur TS, et al.: Repeat FDG-PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer. Ann Thorac Surg 78 (6): 1903-9; discussion 1909, 2004.  [PUBMED Abstract]
  12. Pottgen C, Levegrun S, Theegarten D, et al.: Value of 18F-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography in non-small-cell lung cancer for prediction of pathologic response and times to relapse after neoadjuvant chemoradiotherapy. Clin Cancer Res 12 (1): 97-106, 2006.  [PUBMED Abstract]
  13. Eschmann SM, Friedel G, Paulsen F, et al.: 18F-FDG PET for assessment of therapy response and preoperative re-evaluation after neoadjuvant radio-chemotherapy in stage III non-small cell lung cancer. Eur J Nucl Med Mol Imaging 34 (4): 463-71, 2007.  [PUBMED Abstract]
  14. Hellwig D, Graeter TP, Ukena D, et al.: Value of F-18-fluorodeoxyglucose positron emission tomography after induction therapy of locally advanced bronchogenic carcinoma. J Thorac Cardiovasc Surg 128 (6): 892-9, 2004.  [PUBMED Abstract]
  15. Cerfolio RJ, Bryant AS: When is it best to repeat a 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan on patients with non-small cell lung cancer who have received neoadjuvant chemoradiotherapy? Ann Thorac Surg 84 (4): 1092-7, 2007.  [PUBMED Abstract]
  16. Mac Manus MP, Hicks RJ, Matthews JP, et al.: Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol 21 (7): 1285-92, 2003.  [PUBMED Abstract]

トップ


潜在　非小細胞肺癌の治療

潜在　非小細胞肺癌に対する標準治療の選択肢

潜在非小細胞肺癌に対する標準治療の選択肢は以下です。

  1. 外科療法


０期　非小細胞肺癌の治療

０期非小細胞肺癌に対する標準治療の選択肢

０期非小細胞肺癌に対する標準治療の選択肢は以下です。

  1. 外科療法
  2. 気管支内療法。これは光線力学療法、電気メス療法、凍結療法、ND-YAGレーザー療法を含みます。
参考文献
  1. Woolner LB, Fontana RS, Cortese DA, et al.: Roentgenographically occult lung cancer: pathologic findings and frequency of multicentricity during a 10-year period. Mayo Clin Proc 59 (7): 453-66, 1984.  [PUBMED Abstract]
  2. Venmans BJ, van Boxem TJ, Smit EF, et al.: Outcome of bronchial carcinoma in situ. Chest 117 (6): 1572-6, 2000.  [PUBMED Abstract]
  3. Jeremy George P, Banerjee AK, Read CA, et al.: Surveillance for the detection of early lung cancer in patients with bronchial dysplasia. Thorax 62 (1): 43-50, 2007.  [PUBMED Abstract]
  4. Kennedy TC, McWilliams A, Edell E, et al.: Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132 (3 Suppl): 221S-233S, 2007.  [PUBMED Abstract]
  5. Corti L, Toniolo L, Boso C, et al.: Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma. Lasers Surg Med 39 (5): 394-402, 2007.  [PUBMED Abstract]
  6. Deygas N, Froudarakis M, Ozenne G, et al.: Cryotherapy in early superficial bronchogenic carcinoma. Chest 120 (1): 26-31, 2001.  [PUBMED Abstract]
  7. van Boxem TJ, Venmans BJ, Schramel FM, et al.: Radiographically occult lung cancer treated with fibreoptic bronchoscopic electrocautery: a pilot study of a simple and inexpensive technique. Eur Respir J 11 (1): 169-72, 1998.  [PUBMED Abstract]
  8. van Boxem AJ, Westerga J, Venmans BJ, et al.: Photodynamic therapy, Nd-YAG laser and electrocautery for treating early-stage intraluminal cancer: which to choose? Lung Cancer 31 (1): 31-6, 2001.  [PUBMED Abstract]

トップ


Ⅰ期　非小細胞肺癌の治療

Ⅰ期非小細胞肺癌に対する標準治療の選択肢

Ⅰ期非小細胞肺癌に対する標準治療の選択肢は以下です。
  1. 外科療法
  2. 放射線療法

外科療法は１期非小細胞肺癌に対する治療選択肢です。肺葉切除、区域切除、楔状切除、適切なら袖状切除（気管支形成術）が行われます。

参考文献
  1. Ginsberg RJ, Hill LD, Eagan RT, et al.: Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg 86 (5): 654-8, 1983.  [PUBMED Abstract]
  2. Ginsberg RJ, Rubinstein LV: Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60 (3): 615-22; discussion 622-3, 1995.  [PUBMED Abstract]
  3. Warren WH, Faber LP: Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg 107 (4): 1087-93; discussion 1093-4, 1994.  [PUBMED Abstract]
  4. Mantz CA, Dosoretz DE, Rubenstein JH, et al.: Endobronchial brachytherapy and optimization of local disease control in medically inoperable non-small cell lung carcinoma: a matched-pair analysis. Brachytherapy 3 (4): 183-90, 2004.  [PUBMED Abstract]
  5. Manser R, Wright G, Hart D, et al.: Surgery for early stage non-small cell lung cancer. Cochrane Database Syst Rev (1): CD004699, 2005.  [PUBMED Abstract]
  6. Allen MS, Darling GE, Pechet TT, et al.: Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81 (3): 1013-9; discussion 1019-20, 2006.  [PUBMED Abstract]
  7. Martini N, Bains MS, Burt ME, et al.: Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 109 (1): 120-9, 1995.  [PUBMED Abstract]
  8. PORT Meta-analysis Trialists Group.: Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev (2): CD002142, 2005.  [PUBMED Abstract]
  9. Deygas N, Froudarakis M, Ozenne G, et al.: Cryotherapy in early superficial bronchogenic carcinoma. Chest 120 (1): 26-31, 2001.  [PUBMED Abstract]
  10. van Boxem TJ, Venmans BJ, Schramel FM, et al.: Radiographically occult lung cancer treated with fibreoptic bronchoscopic electrocautery: a pilot study of a simple and inexpensive technique. Eur Respir J 11 (1): 169-72, 1998.  [PUBMED Abstract]
  11. Pignon JP, Tribodet H, Scagliotti GV, et al.: Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 26 (21): 3552-9, 2008.  [PUBMED Abstract]
  12. Winton T, Livingston R, Johnson D, et al.: Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352 (25): 2589-97, 2005.  [PUBMED Abstract]
  13. Arriagada R, Bergman B, Dunant A, et al.: Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350 (4): 351-60, 2004.  [PUBMED Abstract]
  14. Scagliotti GV, Fossati R, Torri V, et al.: Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 95 (19): 1453-61, 2003.  [PUBMED Abstract]
  15. Hotta K, Matsuo K, Ueoka H, et al.: Role of adjuvant chemotherapy in patients with resected non-small-cell lung cancer: reappraisal with a meta-analysis of randomized controlled trials. J Clin Oncol 22 (19): 3860-7, 2004.  [PUBMED Abstract]
  16. Edell ES, Cortese DA: Photodynamic therapy in the management of early superficial squamous cell carcinoma as an alternative to surgical resection. Chest 102 (5): 1319-22, 1992.  [PUBMED Abstract]
  17. Corti L, Toniolo L, Boso C, et al.: Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma. Lasers Surg Med 39 (5): 394-402, 2007.  [PUBMED Abstract]
  18. Strauss GM, Herndon JE 2nd, Maddaus MA, et al.: Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol 26 (31): 5043-51, 2008.  [PUBMED Abstract]
  19. Dosoretz DE, Katin MJ, Blitzer PH, et al.: Radiation therapy in the management of medically inoperable carcinoma of the lung: results and implications for future treatment strategies. Int J Radiat Oncol Biol Phys 24 (1): 3-9, 1992.  [PUBMED Abstract]
  20. Gauden S, Ramsay J, Tripcony L: The curative treatment by radiotherapy alone of stage I non-small cell carcinoma of the lung. Chest 108 (5): 1278-82, 1995.  [PUBMED Abstract]
  21. Noordijk EM, vd Poest Clement E, Hermans J, et al.: Radiotherapy as an alternative to surgery in elderly patients with resectable lung cancer. Radiother Oncol 13 (2): 83-9, 1988.  [PUBMED Abstract]

トップ

Ⅱ期　非小細胞肺癌の治療

Ⅱ期非小細胞肺癌に対する標準治療の選択肢

Ⅱ期非小細胞肺癌に対する標準治療の選択肢は以下です。
  1. 外科療法
  2. 術前化学療法.
  3. 術後化学療法
  4. 放射線療法

参考文献

  1. Manser R, Wright G, Hart D, et al.: Surgery for early stage non-small cell lung cancer. Cochrane Database Syst Rev (1): CD004699, 2005.  [PUBMED Abstract]
  2. Allen MS, Darling GE, Pechet TT, et al.: Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81 (3): 1013-9; discussion 1019-20, 2006.  [PUBMED Abstract]
  3. Burdett SS, Stewart LA, Rydzewska L: Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database Syst Rev (3): CD006157, 2007.  [PUBMED Abstract]
  4. Gilligan D, Nicolson M, Smith I, et al.: Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet 369 (9577): 1929-37, 2007.  [PUBMED Abstract]
  5. PORT Meta-analysis Trialists Group.: Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev (2): CD002142, 2005.  [PUBMED Abstract]
  6. Martini N, Bains MS, Burt ME, et al.: Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 109 (1): 120-9, 1995.  [PUBMED Abstract]
  7. Winton T, Livingston R, Johnson D, et al.: Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352 (25): 2589-97, 2005.  [PUBMED Abstract]
  8. Arriagada R, Bergman B, Dunant A, et al.: Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350 (4): 351-60, 2004.  [PUBMED Abstract]
  9. Pignon JP, Tribodet H, Scagliotti GV, et al.: Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 26 (21): 3552-9, 2008.  [PUBMED Abstract]
  10. Scagliotti GV, Fossati R, Torri V, et al.: Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 95 (19): 1453-61, 2003.  [PUBMED Abstract]
  11. Hotta K, Matsuo K, Ueoka H, et al.: Role of adjuvant chemotherapy in patients with resected non-small-cell lung cancer: reappraisal with a meta-analysis of randomized controlled trials. J Clin Oncol 22 (19): 3860-7, 2004.  [PUBMED Abstract]
  12. Edell ES, Cortese DA: Photodynamic therapy in the management of early superficial squamous cell carcinoma as an alternative to surgical resection. Chest 102 (5): 1319-22, 1992.  [PUBMED Abstract]
  13. Corti L, Toniolo L, Boso C, et al.: Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma. Lasers Surg Med 39 (5): 394-402, 2007.  [PUBMED Abstract]
  14. Douillard JY, Rosell R, De Lena M, et al.: Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 7 (9): 719-27, 2006.  [PUBMED Abstract]
  15. Pepe C, Hasan B, Winton TL, et al.: Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10. J Clin Oncol 25 (12): 1553-61, 2007.  [PUBMED Abstract]
  16. Komaki R, Cox JD, Hartz AJ, et al.: Characteristics of long-term survivors after treatment for inoperable carcinoma of the lung. Am J Clin Oncol 8 (5): 362-70, 1985.  [PUBMED Abstract]
  17. ung: results and implications for future treatment strategies. Int J Radiat Oncol Biol Phys 24 (1): 3-9, 1992.  [PUBMED Abstract]

トップ


ⅢA期　非小細胞肺癌の治療

切除後/切除可能ⅢA期、N2非小細胞肺癌の標準治療の選択肢

切除後あるいは切除可能肺癌の標準治療の選択肢は以下です。

  1. 外科療法
  2. 術前療法
    1. 術前化学療法
  3. 追加療法
    1. 追加化学療法
    2. 追加化学放射線療法
    3. 追加放射線療法

切除不能ⅢA期、N2非小細胞肺癌の標準治療の選択肢

切除不能Ⅲ期、N２非小細胞肺癌の標準治療の選択肢の選択肢は以下です。

  1. 放射線療法
    1. 化学放射線療法の候補にならない、局所進行切除不能肺癌患者さんの治療用.
    2. 姑息的治療を要する患者さん用.
  2. 化学放射線療法


肺尖部胸壁浸潤肺癌（Superior sulcus tumor：T3, N0または1, M0）の標準治療の選択肢

肺尖部胸壁浸潤肺癌の標準治療の選択肢は以下です。

  1. 放射線療法単独．
  2. 放射線療法と外科手術療法．
  3. 放射線療法と外科療法を併用した同時化学療法
  4. 外科手術療法単独（選択された症例）


胸壁浸潤肺癌 (Chest wall tumor：T3, N0または1, M0)の標準治療の選択肢

胸壁浸潤肺癌 (Chest wall tumor)の 標準治療の選択肢は以下です。

  1. 外科手術療法
  2. 外科療法と放射線療法．
  3. 放射線療法単独．
  4. 放射線療法と、外科療法を併用するかしない化学療法を加える．

参考文献

  1. Manser R, Wright G, Hart D, et al.: Surgery for early stage non-small cell lung cancer. Cochrane Database Syst Rev (1): CD004699, 2005.  [PUBMED Abstract]
  2. Allen MS, Darling GE, Pechet TT, et al.: Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81 (3): 1013-9; discussion 1019-20, 2006.  [PUBMED Abstract]
  3. Burdett SS, Stewart LA, Rydzewska L: Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database Syst Rev (3): CD006157, 2007.  [PUBMED Abstract]
  4. Douillard JY, Rosell R, De Lena M, et al.: Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 7 (9): 719-27, 2006.  [PUBMED Abstract]
  5. Gilligan D, Nicolson M, Smith I, et al.: Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet 369 (9577): 1929-37, 2007.  [PUBMED Abstract]
  6. Pignon JP, Tribodet H, Scagliotti GV, et al.: Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 26 (21): 3552-9, 2008.  [PUBMED Abstract]
  7. Winton T, Livingston R, Johnson D, et al.: Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352 (25): 2589-97, 2005.  [PUBMED Abstract]
  8. Arriagada R, Bergman B, Dunant A, et al.: Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 350 (4): 351-60, 2004.  [PUBMED Abstract]
  9. Scagliotti GV, Fossati R, Torri V, et al.: Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 95 (19): 1453-61, 2003.  [PUBMED Abstract]
  10. Hotta K, Matsuo K, Ueoka H, et al.: Role of adjuvant chemotherapy in patients with resected non-small-cell lung cancer: reappraisal with a meta-analysis of randomized controlled trials. J Clin Oncol 22 (19): 3860-7, 2004.  [PUBMED Abstract]
  11. Edell ES, Cortese DA: Photodynamic therapy in the management of early superficial squamous cell carcinoma as an alternative to surgical resection. Chest 102 (5): 1319-22, 1992.  [PUBMED Abstract]
  12. Corti L, Toniolo L, Boso C, et al.: Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma. Lasers Surg Med 39 (5): 394-402, 2007.  [PUBMED Abstract]
  13. Pepe C, Hasan B, Winton TL, et al.: Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10. J Clin Oncol 25 (12): 1553-61, 2007.  [PUBMED Abstract]
  14. PORT Meta-analysis Trialists Group.: Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev (2): CD002142, 2005.  [PUBMED Abstract]
  15. Lally BE, Zelterman D, Colasanto JM, et al.: Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the surveillance, epidemiology, and end results database. J Clin Oncol 24 (19): 2998-3006, 2006.  [PUBMED Abstract]
  16. Johnstone DW, Byhardt RW, Ettinger D, et al.: Phase III study comparing chemotherapy and radiotherapy with preoperative chemotherapy and surgical resection in patients with non-small-cell lung cancer with spread to mediastinal lymph nodes (N2); final report of RTOG 89-01. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 54 (2): 365-9, 2002.  [PUBMED Abstract]
  17. Taylor NA, Liao ZX, Cox JD, et al.: Equivalent outcome of patients with clinical Stage IIIA non-small-cell lung cancer treated with concurrent chemoradiation compared with induction chemotherapy followed by surgical resection. Int J Radiat Oncol Biol Phys 58 (1): 204-12, 2004.  [PUBMED Abstract]
  18. van Meerbeeck JP, Kramer GW, Van Schil PE, et al.: Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst 99 (6): 442-50, 2007.  [PUBMED Abstract]
  19. Komaki R, Cox JD, Hartz AJ, et al.: Characteristics of long-term survivors after treatment for inoperable carcinoma of the lung. Am J Clin Oncol 8 (5): 362-70, 1985.  [PUBMED Abstract]
  20. Saunders M, Dische S, Barrett A, et al.: Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet 350 (9072): 161-5, 1997.  [PUBMED Abstract]
  21. Miller JI Jr, Phillips TW: Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma. Ann Thorac Surg 50 (2): 190-5; discussion 195-6, 1990.  [PUBMED Abstract]
  22. Ung YC, Yu E, Falkson C, et al.: The role of high-dose-rate brachytherapy in the palliation of symptoms in patients with non-small-cell lung cancer: a systematic review. Brachytherapy 5 (3): 189-202, 2006 Jul-Sep.  [PUBMED Abstract]
  23. Sundstrom S, Bremnes R, Aasebo U, et al.: Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 22 (5): 801-10, 2004.  [PUBMED Abstract]
  24. Lester JF, Macbeth FR, Toy E, et al.: Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev (4): CD002143, 2006.  [PUBMED Abstract]
  25. Bezjak A, Dixon P, Brundage M, et al.: Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15). Int J Radiat Oncol Biol Phys 54 (3): 719-28, 2002.  [PUBMED Abstract]
  26. Erridge SC, Gaze MN, Price A, et al.: Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol (R Coll Radiol) 17 (1): 61-7, 2005.  [PUBMED Abstract]
  27. Kramer GW, Wanders SL, Noordijk EM, et al.: Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancer. J Clin Oncol 23 (13): 2962-70, 2005.  [PUBMED Abstract]
  28. Senkus-Konefka E, Dziadziuszko R, Bednaruk-M?y?ski E, et al.: A prospective, randomised study to compare two palliative radiotherapy schedules for non-small-cell lung cancer (NSCLC). Br J Cancer 92 (6): 1038-45, 2005.  [PUBMED Abstract]
  29. Auperin A, Le Pechoux C, Pignon JP, et al.: Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol 17 (3): 473-83, 2006.  [PUBMED Abstract]
  30. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 311 (7010): 899-909, 1995.  [PUBMED Abstract]
  31. Rowell NP, O'rourke NP: Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev (4): CD002140, 2004.  [PUBMED Abstract]
  32. 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 17 (9): 2692-9, 1999.  [PUBMED Abstract]
  33. Curran WJ, Scott CB, Langer CJ, et al.: Long-term benefit is observed in a phase III comparison of sequential vs concurrent chemo-radiation for patients with unresected stage III nsclc: RTOG 9410. [Abstract] Proceedings of the American Society of Clinical Oncology 22: A-2499, 2003. 
  34. Fournel P, Robinet G, Thomas P, et al.: Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 Study. J Clin Oncol 23 (25): 5910-7, 2005.  [PUBMED Abstract]
  35. Zatloukal P, Petruzelka L, Zemanova M, et al.: Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 46 (1): 87-98, 2004.  [PUBMED Abstract]
  36. Rusch VW: Management of Pancoast tumours. Lancet Oncol 7 (12): 997-1005, 2006.  [PUBMED Abstract]
  37. Narayan S, Thomas CR Jr: Multimodality therapy for Pancoast tumor. Nat Clin Pract Oncol 3 (9): 484-91, 2006.  [PUBMED Abstract]
  38. Rusch VW, Parekh KR, Leon L, et al.: Factors determining outcome after surgical resection of T3 and T4 lung cancers of the superior sulcus. J Thorac Cardiovasc Surg 119 (6): 1147-53, 2000.  [PUBMED Abstract]
  39. Kunitoh H, Kato H, Tsuboi M, et al.: Phase II trial of preoperative chemoradiotherapy followed by surgical resection in patients with superior sulcus non-small-cell lung cancers: report of Japan Clinical Oncology Group trial 9806. J Clin Oncol 26 (4): 644-9, 2008.  [PUBMED Abstract]
  40. Rusch VW, Giroux DJ, Kraut MJ, et al.: Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Clin Oncol 25 (3): 313-8, 2007.  [PUBMED Abstract]
  41. Matsuoka H, Nishio W, Okada M, et al.: Resection of chest wall invasion in patients with non-small cell lung cancer. Eur J Cardiothorac Surg 26 (6): 1200-4, 2004.  [PUBMED Abstract]
  42. Facciolo F, Cardillo G, Lopergolo M, et al.: Chest wall invasion in non-small cell lung carcinoma: a rationale for en bloc resection. J Thorac Cardiovasc Surg 121 (4): 649-56, 2001.  [PUBMED Abstract]
  43. Doddoli C, D'Journo B, Le Pimpec-Barthes F, et al.: Lung cancer invading the chest wall: a plea for en-bloc resection but the need for new treatment strategies. Ann Thorac Surg 80 (6): 2032-40, 2005.  [PUBMED Abstract]

トップ

ⅢB期　非小細胞肺癌の治療

ⅢB期非小細胞肺癌の標準治療の選択肢

ⅢB期非小細胞肺癌の標準治療の選択肢は以下です。
  1. 異時または同時、放射線化学療法
  2. 化学療法、外科療法が続く（選択された患者さん用）
  3. 放射線療法単独.
    1. 局所進行で外科切除不能患者さんで、化学療法の候補にならない患者さん用
    2. 姑息的治療を行う患者さん用

参考文献

  1. Wisnivesky JP, Yankelevitz D, Henschke CI: Stage of lung cancer in relation to its size: part 2. Evidence. Chest 127 (4): 1136-9, 2005.  [PUBMED Abstract]
  2. Mountain CF: Revisions in the International System for Staging Lung Cancer. Chest 111 (6): 1710-7, 1997.  [PUBMED Abstract]
  3. Deslauriers J, Brisson J, Cartier R, et al.: Carcinoma of the lung. Evaluation of satellite nodules as a factor influencing prognosis after resection. J Thorac Cardiovasc Surg 97 (4): 504-12, 1989.  [PUBMED Abstract]
  4. Urschel JD, Urschel DM, Anderson TM, et al.: Prognostic implications of pulmonary satellite nodules: are the 1997 staging revisions appropriate? Lung Cancer 21 (2): 83-7; discussion 89-91, 1998.  [PUBMED Abstract]
  5. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 311 (7010): 899-909, 1995.  [PUBMED Abstract]
  6. Rowell NP, O'rourke NP: Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev (4): CD002140, 2004.  [PUBMED Abstract]
  7. Auperin A, Le Pechoux C, Pignon JP, et al.: Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol 17 (3): 473-83, 2006.  [PUBMED Abstract]
  8. 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 17 (9): 2692-9, 1999.  [PUBMED Abstract]
  9. Curran WJ, Scott CB, Langer CJ, et al.: Long-term benefit is observed in a phase III comparison of sequential vs concurrent chemo-radiation for patients with unresected stage III nsclc: RTOG 9410. [Abstract] Proceedings of the American Society of Clinical Oncology 22: A-2499, 2003. 
  10. Fournel P, Robinet G, Thomas P, et al.: Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 Study. J Clin Oncol 23 (25): 5910-7, 2005.  [PUBMED Abstract]
  11. Zatloukal P, Petruzelka L, Zemanova M, et al.: Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 46 (1): 87-98, 2004.  [PUBMED Abstract]
  12. Langendijk JA, ten Velde GP, Aaronson NK, et al.: Quality of life after palliative radiotherapy in non-small cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 47 (1): 149-55, 2000.  [PUBMED Abstract]
  13. Komaki R, Cox JD, Hartz AJ, et al.: Characteristics of long-term survivors after treatment for inoperable carcinoma of the lung. Am J Clin Oncol 8 (5): 362-70, 1985.  [PUBMED Abstract]
  14. Miller JI Jr, Phillips TW: Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma. Ann Thorac Surg 50 (2): 190-5; discussion 195-6, 1990.  [PUBMED Abstract]
  15. Ung YC, Yu E, Falkson C, et al.: The role of high-dose-rate brachytherapy in the palliation of symptoms in patients with non-small-cell lung cancer: a systematic review. Brachytherapy 5 (3): 189-202, 2006 Jul-Sep.  [PUBMED Abstract]
  16. Sundstrom S, Bremnes R, Aasebo U, et al.: Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 22 (5): 801-10, 2004.  [PUBMED Abstract]
  17. Lester JF, Macbeth FR, Toy E, et al.: Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev (4): CD002143, 2006.  [PUBMED Abstract]
  18. Bezjak A, Dixon P, Brundage M, et al.: Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15). Int J Radiat Oncol Biol Phys 54 (3): 719-28, 2002.  [PUBMED Abstract]
  19. Erridge SC, Gaze MN, Price A, et al.: Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol (R Coll Radiol) 17 (1): 61-7, 2005.  [PUBMED Abstract]
  20. Kramer GW, Wanders SL, Noordijk EM, et al.: Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancer. J Clin Oncol 23 (13): 2962-70, 2005.  [PUBMED Abstract]
  21. Senkus-Konefka E, Dziadziuszko R, Bednaruk-M?y?ski E, et al.: A prospective, randomised study to compare two palliative radiotherapy schedules for non-small-cell lung cancer (NSCLC). Br J Cancer 92 (6): 1038-45, 2005.  [PUBMED Abstract]

トップ

Ⅳ期　非小細胞肺癌の治療

Ⅳ期　非小細胞肺癌の標準治療の選択肢

Ⅳ期非小細胞肺癌の標準治療の選択肢は以下のです。
  1. 細胞障害性併用化学療法、これはプラチナ製剤(シスプラチンcisplatin またはカルボプラチンcarboplatin)とパクリタキセルpaclitaxel, ゲムシタビンgemcitabine, ドセタキセルdocetaxel, ビノレルビンvinorelbine, イリノテカンirinotecan, ペメトレキセドpemetrexedを用いる
    1. 治療に影響する因子
      1. 組織型
      2. 年齢と併存疾患
      3. 全身状態
  2. ベバシズマブbevacizumabまたはセツキシマブcetuximab による併用化学療法(非扁平上皮癌、無脳転移、無喀血患者さん用).
  3. 上皮成長因子受容体チロシンキナーゼ阻害剤（上皮成長因子受容体（epidermal growth factor receptor（EGFR））遺伝子変異陽性患者さん用）
  4. シスプラチンCisplatin, ビノレルビンvinorelbine 、セツキシマブcetuximab（上皮成長因子受容体（epidermal growth factor receptor（EGFR））を発現した非小細胞肺癌（NSCLC）患者さん用）
  5. 維持化学療法ペメトレキセドpemetrexed（４サイクルの非ペメトレキセドとプラチナ製剤(シスプラチンcisplatin またはカルボプラチンcarboplatin)による併用化学療法により不変または有効患者さん用）
  6. 外照射療法（external beam radiation therapy（EBRT））（局所有症状腫瘍増殖を緩和）.[1-3]
  7. 気管支内レーザー療法および/または腔内照射療法（気管支閉塞病変用）.[4]

参考文献

  1. Bezjak A, Dixon P, Brundage M, et al.: Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15). Int J Radiat Oncol Biol Phys 54 (3): 719-28, 2002.  [PUBMED Abstract]
  2. Macbeth F, Toy E, Coles B, et al.: Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev (3): CD002143, 2001.  [PUBMED Abstract]
  3. Sundstrom S, Bremnes R, Aasebo U, et al.: Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 22 (5): 801-10, 2004.  [PUBMED Abstract]
  4. Miller JI Jr, Phillips TW: Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma. Ann Thorac Surg 50 (2): 190-5; discussion 195-6, 1990.  [PUBMED Abstract]
  5. Weick JK, Crowley J, Natale RB, et al.: A randomized trial of five cisplatin-containing treatments in patients with metastatic non-small-cell lung cancer: a Southwest Oncology Group study. J Clin Oncol 9 (7): 1157-62, 1991.  [PUBMED Abstract]
  6. Delbaldo C, Michiels S, Rolland E, et al.: Second or third additional chemotherapy drug for non-small cell lung cancer in patients with advanced disease. Cochrane Database Syst Rev (4): CD004569, 2007.  [PUBMED Abstract]
  7. Ardizzoni A, Boni L, Tiseo M, et al.: Cisplatin- versus carboplatin-based chemotherapy in first-line treatment of advanced non-small-cell lung cancer: an individual patient data meta-analysis. J Natl Cancer Inst 99 (11): 847-57, 2007.  [PUBMED Abstract]
  8. Jiang J, Liang X, Zhou X, et al.: A meta-analysis of randomized controlled trials comparing carboplatin-based to cisplatin-based chemotherapy in advanced non-small cell lung cancer. Lung Cancer 57 (3): 348-58, 2007.  [PUBMED Abstract]
  9. Hotta K, Matsuo K, Ueoka H, et al.: Meta-analysis of randomized clinical trials comparing Cisplatin to Carboplatin in patients with advanced non-small-cell lung cancer. J Clin Oncol 22 (19): 3852-9, 2004.  [PUBMED Abstract]
  10. D'Addario G, Pintilie M, Leighl NB, et al.: Platinum-based versus non-platinum-based chemotherapy in advanced non-small-cell lung cancer: a meta-analysis of the published literature. J Clin Oncol 23 (13): 2926-36, 2005.  [PUBMED Abstract]
  11. Rajeswaran A, Trojan A, Burnand B, et al.: Efficacy and side effects of cisplatin- and carboplatin-based doublet chemotherapeutic regimens versus non-platinum-based doublet chemotherapeutic regimens as first line treatment of metastatic non-small cell lung carcinoma: a systematic review of randomized controlled trials. Lung Cancer 59 (1): 1-11, 2008.  [PUBMED Abstract]
  12. Pujol JL, Barlesi F, Daures JP: Should chemotherapy combinations for advanced non-small cell lung cancer be platinum-based? A meta-analysis of phase III randomized trials. Lung Cancer 51 (3): 335-45, 2006.  [PUBMED Abstract]
  13. Douillard JY, Laporte S, Fossella F, et al.: Comparison of docetaxel- and vinca alkaloid-based chemotherapy in the first-line treatment of advanced non-small cell lung cancer: a meta-analysis of seven randomized clinical trials. J Thorac Oncol 2 (10): 939-46, 2007.  [PUBMED Abstract]
  14. Belani CP, Ramalingam S, Perry MC, et al.: Randomized, phase III study of weekly paclitaxel in combination with carboplatin versus standard every-3-weeks administration of carboplatin and paclitaxel for patients with previously untreated advanced non-small-cell lung cancer. J Clin Oncol 26 (3): 468-73, 2008.  [PUBMED Abstract]
  15. Schuette W, Blankenburg T, Guschall W, et al.: Multicenter randomized trial for stage IIIB/IV non-small-cell lung cancer using every-3-week versus weekly paclitaxel/carboplatin. Clin Lung Cancer 7 (5): 338-43, 2006.  [PUBMED Abstract]
  16. Scagliotti GV, Parikh P, von Pawel J, et al.: Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 26 (21): 3543-51, 2008.  [PUBMED Abstract]
  17. Langer CJ, Vangel M, Schiller J, et al.: Age-specific subanalysis of ECOG 1594: fit elderly patients (70-80 YRS) with NSCLC do as well as younger pts (<70). [Abstract] Proceedings of the American Society of Clinical Oncology 22: A-2571, 2003. 
  18. Langer CJ, Manola J, Bernardo P, et al.: Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Natl Cancer Inst 94 (3): 173-81, 2002.  [PUBMED Abstract]
  19. Ries LA: Influence of extent of disease, histology, and demographic factors on lung cancer survival in the SEER population-based data. Semin Surg Oncol 10 (1): 21-30, 1994 Jan-Feb.  [PUBMED Abstract]
  20. Ramsey SD, Howlader N, Etzioni RD, et al.: Chemotherapy use, outcomes, and costs for older persons with advanced non-small-cell lung cancer: evidence from surveillance, epidemiology and end results-Medicare. J Clin Oncol 22 (24): 4971-8, 2004.  [PUBMED Abstract]
  21. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. The Elderly Lung Cancer Vinorelbine Italian Study Group. J Natl Cancer Inst 91 (1): 66-72, 1999.  [PUBMED Abstract]
  22. Takeda K, Kudoh S, Nakagawa K, et al.: Randomized phase III study of docetaxel (D) versus vinorelbine (V) for elderly patients (pts) with advanced non-small cell lung cancer (NSCLC): Results of a West Japan Thoracic Oncology Group trial (WJTOG9904). [Abstract] J Clin Oncol 23 (Suppl 16): A-7009, 2005. 
  23. Schiller JH, Harrington D, Belani CP, et al.: Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 346 (2): 92-8, 2002.  [PUBMED Abstract]
  24. Belani CP, Fossella F: Elderly subgroup analysis of a randomized phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for first-line treatment of advanced nonsmall cell lung carcinoma (TAX 326). Cancer 104 (12): 2766-74, 2005.  [PUBMED Abstract]
  25. Lilenbaum RC, Herndon JE 2nd, List MA, et al.: Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730). J Clin Oncol 23 (1): 190-6, 2005.  [PUBMED Abstract]
  26. Hensing TA, Peterman AH, Schell MJ, et al.: The impact of age on toxicity, response rate, quality of life, and survival in patients with advanced, Stage IIIB or IV nonsmall cell lung carcinoma treated with carboplatin and paclitaxel. Cancer 98 (4): 779-88, 2003.  [PUBMED Abstract]
  27. Sweeney CJ, Zhu J, Sandler AB, et al.: Outcome of patients with a performance status of 2 in Eastern Cooperative Oncology Group Study E1594: a Phase II trial in patients with metastatic nonsmall cell lung carcinoma . Cancer 92 (10): 2639-47, 2001.  [PUBMED Abstract]
  28. Tester WJ, Stephenson P, Langer CJ, et al.: ECOG 1599: randomized phase II study of paclitaxel/carboplatin or gemcitabine/cisplatin in performance status (PS) 2 patients with advanced non-small cell lung cancer (NSCLC). [Abstract] J Clin Oncol 22 (Suppl 14): A-7055, 630s, 2004. 
  29. Vansteenkiste JF, Vandebroek JE, Nackaerts KL, et al.: Clinical-benefit response in advanced non-small-cell lung cancer: A multicentre prospective randomised phase III study of single agent gemcitabine versus cisplatin-vindesine. Ann Oncol 12 (9): 1221-30, 2001.  [PUBMED Abstract]
  30. Hickish TF, Smith IE, O'Brien ME, et al.: Clinical benefit from palliative chemotherapy in non-small-cell lung cancer extends to the elderly and those with poor prognostic factors. Br J Cancer 78 (1): 28-33, 1998.  [PUBMED Abstract]
  31. Sandler A, Gray R, Perry MC, et al.: Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 355 (24): 2542-50, 2006.  [PUBMED Abstract]
  32. Reck M, von Pawel J, Zatloukal P, et al.: Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer: AVAil. J Clin Oncol 27 (8): 1227-34, 2009.  [PUBMED Abstract]
  33. Lynch TJ, Patel T, Dreisbach L, et al.: Cetuximab and first-line taxane/carboplatin chemotherapy in advanced non-small-cell lung cancer: results of the randomized multicenter phase III trial BMS099. J Clin Oncol 28 (6): 911-7, 2010.  [PUBMED Abstract]
  34. Pirker R, Pereira JR, Szczesna A, et al.: Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial. Lancet 373 (9674): 1525-31, 2009.  [PUBMED Abstract]
  35. Khambata-Ford S, Harbison CT, Hart LL, et al.: Analysis of potential predictive markers of cetuximab benefit in BMS099, a phase III study of cetuximab and first-line taxane/carboplatin in advanced non-small-cell lung cancer. J Clin Oncol 28 (6): 918-27, 2010.  [PUBMED Abstract]
  36. Mok TS, Wu YL, Thongprasert S, et al.: Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 361 (10): 947-57, 2009.  [PUBMED Abstract]
  37. Brodowicz T, Krzakowski M, Zwitter M, et al.: Cisplatin and gemcitabine first-line chemotherapy followed by maintenance gemcitabine or best supportive care in advanced non-small cell lung cancer: a phase III trial. Lung Cancer 52 (2): 155-63, 2006.  [PUBMED Abstract]
  38. Park JO, Kim SW, Ahn JS, et al.: Phase III trial of two versus four additional cycles in patients who are nonprogressive after two cycles of platinum-based chemotherapy in non small-cell lung cancer. J Clin Oncol 25 (33): 5233-9, 2007.  [PUBMED Abstract]
  39. Socinski MA, Schell MJ, Peterman A, et al.: Phase III trial comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced-stage IIIB/IV non-small-cell lung cancer. J Clin Oncol 20 (5): 1335-43, 2002.  [PUBMED Abstract]
  40. von Plessen C, Bergman B, Andresen O, et al.: Palliative chemotherapy beyond three courses conveys no survival or consistent quality-of-life benefits in advanced non-small-cell lung cancer. Br J Cancer 95 (8): 966-73, 2006.  [PUBMED Abstract]
  41. Ciuleanu T, Brodowicz T, Zielinski C, et al.: Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 374 (9699): 1432-40, 2009.  [PUBMED Abstract]
  42. Danson S, Middleton MR, O'Byrne KJ, et al.: Phase III trial of gemcitabine and carboplatin versus mitomycin, ifosfamide, and cisplatin or mitomycin, vinblastine, and cisplatin in patients with advanced nonsmall cell lung carcinoma. Cancer 98 (3): 542-53, 2003.  [PUBMED Abstract]
  43. Pfister DG, Johnson DH, Azzoli CG, et al.: American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. J Clin Oncol 22 (2): 330-53, 2004.  [PUBMED Abstract]
  44. Smit EF, van Meerbeeck JP, Lianes P, et al.: Three-arm randomized study of two cisplatin-based regimens and paclitaxel plus gemcitabine in advanced non-small-cell lung cancer: a phase III trial of the European Organization for Research and Treatment of Cancer Lung Cancer Group--EORTC 08975. J Clin Oncol 21 (21): 3909-17, 2003.  [PUBMED Abstract]
  45. Kubota K, Watanabe K, Kunitoh H, et al.: Phase III randomized trial of docetaxel plus cisplatin versus vindesine plus cisplatin in patients with stage IV non-small-cell lung cancer: the Japanese Taxotere Lung Cancer Study Group. J Clin Oncol 22 (2): 254-61, 2004.  [PUBMED Abstract]
  46. Georgoulias V, Ardavanis A, Agelidou A, et al.: Docetaxel versus docetaxel plus cisplatin as front-line treatment of patients with advanced non-small-cell lung cancer: a randomized, multicenter phase III trial. J Clin Oncol 22 (13): 2602-9, 2004.  [PUBMED Abstract]
  47. Sandler AB, Nemunaitis J, Denham C, et al.: Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol 18 (1): 122-30, 2000.  [PUBMED Abstract]
  48. Lester JF, Macbeth FR, Toy E, et al.: Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev (4): CD002143, 2006.  [PUBMED Abstract]
  49. Ung YC, Yu E, Falkson C, et al.: The role of high-dose-rate brachytherapy in the palliation of symptoms in patients with non-small-cell lung cancer: a systematic review. Brachytherapy 5 (3): 189-202, 2006 Jul-Sep.  [PUBMED Abstract]

トップ

再発非小細胞肺癌の治療

再発非小細胞肺癌に対する標準治療の選択肢

再発非小細胞肺癌に対する標準治療の選択肢は以下です。

  1. 放射線療法(姑息的目的）.[1]

  2. 化学療法単独．以前にプラチナ製剤による化学療法を受けた患者さんには次の化学療法薬を含みます。

    1. ドセタキセルDocetaxel.[2,3]
    2. ペメトレキセドPemetrexed.[3]
    3. エルロチニブErlotinib、これはプラチナplatinumを組み合わせた化学療法およびドセタキセルdocetaxel化学療法が無効時.[4]
    4. ゲフィチニブGefitinib.[5]
  3. 単発脳転移の外科手術療法（厳選された患者さん用）.[6]
  4. レーザー療法あるいは内部照射療法（気管支内病変用）.[7]
  5. 立体的放射線外科療法（厳選された患者さん）.[8,9]

放射線療法は局所腫瘍による症状の良好な改善をもたらす可能性がある。

参考文献

  1. Sundstrom S, Bremnes R, Aasebo U, et al.: Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 22 (5): 801-10, 2004.  [PUBMED Abstract]
  2. Shepherd FA, Dancey J, Ramlau R, et al.: Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol 18 (10): 2095-103, 2000.  [PUBMED Abstract]
  3. Hanna N, Shepherd FA, Fossella FV, et al.: Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol 22 (9): 1589-97, 2004.  [PUBMED Abstract]
  4. Shepherd FA, Pereira J, Ciuleanu TE, et al.: A randomized placebo-controlled trial of erlotinib in patients with advanced non-small cell lung cancer (NSCLC) following failure of 1st line or 2nd line chemotherapy. A National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) trial. [Abstract] J Clin Oncol 22 (Suppl 14): A-7022, 622s, 2004. 
  5. Kim ES, Hirsh V, Mok T, et al.: Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST): a randomised phase III trial. Lancet 372 (9652): 1809-18, 2008.  [PUBMED Abstract]
  6. Arbit E, Wro?ski M, Burt M, et al.: The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 76 (5): 765-73, 1995.  [PUBMED Abstract]
  7. Miller JI Jr, Phillips TW: Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma. Ann Thorac Surg 50 (2): 190-5; discussion 195-6, 1990.  [PUBMED Abstract]
  8. Loeffler JS, Kooy HM, Wen PY, et al.: The treatment of recurrent brain metastases with stereotactic radiosurgery. J Clin Oncol 8 (4): 576-82, 1990.  [PUBMED Abstract]
  9. Alexander E 3rd, Moriarty TM, Davis RB, et al.: Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 87 (1): 34-40, 1995.  [PUBMED Abstract]
  10. Souquet PJ, Chauvin F, Boissel JP, et al.: Polychemotherapy in advanced non small cell lung cancer: a meta-analysis. Lancet 342 (8862): 19-21, 1993.  [PUBMED Abstract]
  11. Ellis PA, Smith IE, Hardy JR, et al.: Symptom relief with MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in advanced non-small-cell lung cancer. Br J Cancer 71 (2): 366-70, 1995.  [PUBMED Abstract]
  12. Girling DJ, et al.: Randomized trial of etoposide cyclophosphamide methotrexate and vincristine versus etoposide and vincristine in the palliative treatment of patients with small-cell lung cancer and poor prognosis. Br J Cancer 67 (Suppl 20): A-4;2, 14, 1993. 
  13. Fossella FV, DeVore R, Kerr RN, et al.: Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. The TAX 320 Non-Small Cell Lung Cancer Study Group. J Clin Oncol 18 (12): 2354-62, 2000.  [PUBMED Abstract]
  14. Huisman C, Smit EF, Giaccone G, et al.: Second-line chemotherapy in relapsing or refractory non-small-cell lung cancer: a review. J Clin Oncol 18 (21): 3722-30, 2000.  [PUBMED Abstract]
  15. Di Maio M, Perrone F, Chiodini P, et al.: Individual patient data meta-analysis of docetaxel administered once every 3 weeks compared with once every week second-line treatment of advanced non-small-cell lung cancer. J Clin Oncol 25 (11): 1377-82, 2007.  [PUBMED Abstract]
  16. Scagliotti G, Hanna N, Fossella F, et al.: The differential efficacy of pemetrexed according to NSCLC histology: a review of two Phase III studies. Oncologist 14 (3): 253-63, 2009.  [PUBMED Abstract]
  17. Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al.: Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 353 (2): 123-32, 2005.  [PUBMED Abstract]
  18. Bezjak A, Tu D, Seymour L, et al.: Symptom improvement in lung cancer patients treated with erlotinib: quality of life analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol 24 (24): 3831-7, 2006.  [PUBMED Abstract]
  19. Herbst RS, Prager D, Hermann R, et al.: TRIBUTE - A phase III trial of erlotinib HCI (OSI-774) combined with carboplatin and paclitaxel (CP) chemotherapy in advanced non-small cell lung cancer (NSCLC). [Abstract] J Clin Oncol 22 (Suppl 14): A-7011, 619s, 2004. 
  20. Gatzemeier U, Pluzanska A, Szczesna A, et al.: Results of a phase III trial of erlotinib (OSI-774) combined with cisplatin and gemcitabine (GC) chemotherapy in advanced non-small cell lung cancer (NSCLC). [Abstract] J Clin Oncol 22 (Suppl 14): A-7010, 619s, 2004. 
  21. Thatcher N, Chang A, Parikh P, et al.: Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer). Lancet 366 (9496): 1527-37, 2005 Oct 29-Nov 4.  [PUBMED Abstract]
  22. Herbst RS, Giaccone G, Schiller JH, et al.: Gefitinib in combination with paclitaxel and carboplatin in advanced non-small-cell lung cancer: a phase III trial--INTACT 2. J Clin Oncol 22 (5): 785-94, 2004.  [PUBMED Abstract]
  23. Giaccone G, Herbst RS, Manegold C, et al.: Gefitinib in combination with gemcitabine and cisplatin in advanced non-small-cell lung cancer: a phase III trial--INTACT 1. J Clin Oncol 22 (5): 777-84, 2004.  [PUBMED Abstract]
  24. Miller VA, Kris MG, Shah N, et al.: Bronchioloalveolar pathologic subtype and smoking history predict sensitivity to gefitinib in advanced non-small-cell lung cancer. J Clin Oncol 22 (6): 1103-9, 2004.  [PUBMED Abstract]
  25. Paez JG, Janne PA, Lee JC, et al.: EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Science 304 (5676): 1497-500, 2004.  [PUBMED Abstract]
  26. Lynch TJ, Bell DW, Sordella R, et al.: Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 350 (21): 2129-39, 2004.  [PUBMED Abstract]
  27. Pao W, Miller V, Zakowski M, et al.: EGF receptor gene mutations are common in lung cancers from "never smokers" and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci U S A 101 (36): 13306-11, 2004.  [PUBMED Abstract]
  28. Pao W, Wang TY, Riely GJ, et al.: KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. PLoS Med 2 (1): e17, 2005.  [PUBMED Abstract]
  29. Tsao MS, Sakurada A, Cutz JC, et al.: Erlotinib in lung cancer - molecular and clinical predictors of outcome. N Engl J Med 353 (2): 133-44, 2005.  [PUBMED Abstract]
  30. Hirsch FR, Varella-Garcia M, Bunn PA Jr, et al.: Molecular predictors of outcome with gefitinib in a phase III placebo-controlled study in advanced non-small-cell lung cancer. J Clin Oncol 24 (31): 5034-42, 2006.  [PUBMED Abstract]
  31. Clark GM, Zborowski DM, Culbertson JL, et al.: Clinical utility of epidermal growth factor receptor expression for selecting patients with advanced non-small cell lung cancer for treatment with erlotinib. J Thorac Oncol 1 (8): 837-46, 2006.  [PUBMED Abstract]
  32. Salerno TA, Munro DD, Blundell PE, et al.: Second primary bronchogenic carcinoma: life-table analysis of surgical treatment. Ann Thorac Surg 27 (1): 3-6, 1979.  [PUBMED Abstract]
  33. Yellin A, Hill LR, Benfield JR: Bronchogenic carcinoma associated with upper aerodigestive cancers. J Thorac Cardiovasc Surg 91 (5): 674-83, 1986.  [PUBMED Abstract]
  34. Patchell RA, Tibbs PA, Walsh JW, et al.: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322 (8): 494-500, 1990.  [PUBMED Abstract]
  35. Mandell L, Hilaris B, Sullivan M, et al.: The treatment of single brain metastasis from non-oat cell lung carcinoma. Surgery and radiation versus radiation therapy alone. Cancer 58 (3): 641-9, 1986.  [PUBMED Abstract]
  36. DeAngelis LM, Mandell LR, Thaler HT, et al.: The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery 24 (6): 798-805, 1989.  [PUBMED Abstract]
  37. Hazuka MB, Kinzie JJ: Brain metastases: results and effects of re-irradiation. Int J Radiat Oncol Biol Phys 15 (2): 433-7, 1988.  [PUBMED Abstract]

トップ

薬剤名) 一般名：略語（商品名：略語）

シクロフォスファミド：CPA（エンドキサン）
イホスファミド：IFM（イホマイド（ifosfamide））

ゲムシタビン（gemcitabine）：GEM（ジェムザール）
テガフール・ウラシル配合剤（ユーエフティ：UFT）

ビンクリスチン：VCR（オンコビン）
ビンブラスチン：VLB、VBL（エクザール）
ビンデシン：VDS（ フィルデシン）
ビノレルビン（vinorelbine）：VNR（ナベルビン）
パクリタキセル：PTX （タキソール：TAX、TXO）
ドセタキセルdocetaxel：DTX（タキソテールTaxotere：TXT）

エトポシド：VP-16、ETP（ラステット、ベプシド）
イリノテカンCPT-11（カンプト、トポテシン）
トポテカン：ハイカムチン

ドキソルビシン、アドリアマイシン：ADR、ADM 、DXR、DOX（アドリアシン）
マイトマイシン：MMC（マイトマイシン）
エピルビシン：EPI（ファルモルビシン）

シスプラチン（cisplatin）：CDDP（ランダ、ブリプラチン）
カルボプラチン（carboplatin）：CBDCA（パラプラチン）

セツキシマブ（Cetuximab）：アービタックス（Erbitux）
ペメトレキセド（Pemetrexed）：アリムタ（Alimta）
ベバシズマブ（Bevacizumab）：アバスチン（Avastin）
エルロチニブ（Erlotinib）：タルセバ（Tarceba）
ゲフィチニブ（Gefitinib）：イレッサ（Iressa）
アムルビシン（Amrubicin）：カルセド（Calsed）

トップ

重要：この情報は、主として医師、および他の医療従事者のためのものです。あなたがこの話題に関して質問をお持ちの場合、あなたの主治医に尋ねてください。

2011年6月最新版（2011年7月更新)