问答题 For the first time in decades, doctors have begun making major changes in the treatment of lung cancer, based on research proving that chemotherapy can significantly lengthen life for many patients for whom it was previously thought to be useless.
The shift in care applies to about 50,000 people a year in the United States who have early cases of the most common form of the disease, non-small-cell lung cancer, and whose tumors are removed by surgery. (46) Many of these patients, who just a few years ago would have been treated with surgery alone, are now being given chemotherapy as well, just as. it is routinely given after surgery for breast or colon (结肠)cancer. The new approach has brightened a picture that was often bleak.
"The benefit is at least as good, and maybe better than in the other cancers," said Dr. John Minna, a lung cancer expert and research director at the University of Texas Southwestern Medical Center in Dallas. He said new discoveries were helping to eliminate doctors' "nihilistic" attitudes about chemotherapy for lung cancer.
"The standard of care has changed," said Dr. Christopher G. Azzoli, a lung cancer specialist at Memorial Sloan-Kettering Cancer Center in New York.
(47) A major impetus for the change came a year ago, when two studies presented at a cancer conference showed marked increases in survival in patients who received adjuvant (辅助的)chemotherapy, meaning the drugs were given after surgery. In one study of 482 patients in Canada and the United States, led by Dr. Timothy Winton, a surgeon from the University of Alberta, 69 percent of patients who had surgery and chemotherapy were still alive five years later, as compared with 54 percent who had just surgery. The patients were given a combination of two drugs, cisplatin and vinorelbine, once a week for 16 weeks.
In the world of lung cancer research, a survival difference of 15 percentage points is enormous. (48) Overall, the patients given chemotherapy lived 94 months, versus 73 months in those who had only surgery—also a huge difference in a field in which a treatment is hailed as a success if it gives patients even three or four extra months.
A second study, also announced at the conference last year, had similar findings, and so did a third, presented just a month ago at the annual meeting of the same cancer group, the American Society of Clinical Oneology.
At major medical centers, doctors quickly began to put the results into practice.
(49) "The findings were so stunning from these studies a year ago that they began to change the standard of care," said Dr. Pasi Janne, a lung cancer specialist at the Dana Farber Cancer Institute in Boston. "Over the last year, the number of patients we've had referred here for adjuvant chemotherapy has gone up steadily."
(50) But some doctors hesitated to make changes, Dr. Winton said, wanting first to see the studies published in a medical journal, which would mean the data had stood up to the serutiny(仔细的检查) of editors and expert reviewers.
Now, his study has become the first of the three to pass that test. It is being published today in The New England Journal of Medicine, along with an editorial by Dr. Katherine M. S. Pisters, a lung cancer specialist at the m. D. Anderson Cancer Center in Houston.