CANCERS BRONCHIQUES NON A PETITES CELLULES RESECABLES |
|
|
référence |
traitement |
stade |
n |
% RO |
survie médiane |
survie à 3 ans |
p |
|
CHIRURGIE VERSUS RADIOTHERAPIE |
|||||||
|
Johnstone, 2002 (1)
|
CDDP-MMC-VBL
2 cures |
IIIA
N2 |
|
|
|
|
NS |
|
I. chirurgie
puis 2 cures |
22 |
|
19,4
mo |
|
|||
|
II. RT (64
Gy) puis 2 cures |
23 |
|
17,4
mo |
|
|||
|
Stephens, 2005 (2) |
I. 4 x MMC-VBL-CDP puis chirurgie |
IIIA |
24 |
4 opérés |
13,8 mo |
|
NS |
|
II. RT (50-60 Gy) |
24 |
|
11,2 mo |
|
|||
|
van Meerbeeck, 2007 (3) |
CDDP (> 80 mg/m²) ou
carboplatine + gemcitabine ou taxane x 3 cycles |
IIIA N2 non résécable avec
réponse |
579 |
61 % |
15,4 mo |
(5 ans) |
NS (0,6) |
|
I. Radiothérapie 60-62,5 Gy |
154/ 165 |
|
|
14 % |
|||
|
II. Chirurgie (+ RT postop si
incomplète) |
154/ 167 |
|
|
15,7 % |
|||
|
Albain, 2009 (4) |
2 x CDDP-VP16 avec RT (45Gy) |
IIIA N2 résécable |
|
|
|
|
|
|
I. Chirurgie puis 2 chimio |
202 |
|
|
|
0,24 |
||
|
II RT (61 Gy) puis 2 chimio |
194 |
|
|
|
|||
|
CHIMIOTHERAPIE VERSUS
RADIOCHIMIOTHERAPIE AVANT CHIRURGIE |
|||||||
|
Thomas, 2008 (5) |
I. 3x cisplatine+VP16 puis RT bid
avec carbo_VDS puis chirurgie |
III |
264 |
37 % Rés compl |
|
|
NS |
|
II. 3x cisplatine+VP16 puis
chirurgie puis RT |
260 |
32 % Rés compl |
|
|
|||
|
CHIRURGIE AVEC OU SANS CHIMIOTHERAPIE
(NEO)ADJUVANTE |
|||||||
|
Felip, 2010 (6) A |
I. Chirurgie |
IA, IB, II, T3N1 |
212 |
|
|
(5ana) 44 % |
NS |
|
II Chimio Préop (3x carbo-paclitaxel) |
201 |
53 % |
|
46,6 % |
|||
|
III. Chimio Postop (3x carbo-paclitaxel) |
211 |
|
|
45,5 % |
|||
Références
(1) Johnstone DW, Byhardt RW, Ettinger D, Scott CB. 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 2002 Oct 1;54(2):365-9.
(2) Stephens RJ, Girling DJ, Hopwood P, Thatcher N. A randomised controlled trial of pre-operative chemotherapy followed, if feasible, by resection versus radiotherapy in patients with inoperable stage T3, N1, M0 or T1-3, N2, M0 non-small cell lung cancer. Lung Cancer 2005 Sep;49(3):395-400.
(3) van Meerbeeck JP, Kramer GW, Van Schil PE, Legrand C, Smit EF, Schramel F, 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 2007 Mar 21;99(6):442-50.
(4) Albain KS, Swann RS, Rusch VW, Turrisi AT, III, Shepherd FA, Smith C, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 2009 Aug 1;374(9687):379-86.
(5) Thomas M, Rube C, Hoffknecht P, Macha HN, Freitag L, Linder A, et al. Effect of preoperative chemoradiation in addition to preoperative chemotherapy: a randomised trial in stage III non-small-cell lung cancer. Lancet Oncol 2008 Jul;9(7):636-48.
(6) Felip E, Rosell R, Maestre JA, Rodriguez-Paniagua JM, Moran T, Astudillo J, et al. Preoperative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage non-small-cell lung cancer. J Clin Oncol 2010 Jul 1;28(19):3138-45.