4

小细胞肺癌的治疗方法概述

研究发现化疗与放疗改善小细胞肺癌(SCLC)患者的生存。

化疗

尽管治疗已有显著进展,绝大多数SCLC患者经最佳治疗后仍然因肿瘤死亡。生存时间延长的SCLC患者中多数是因为参与临床试验,得到了最佳、最适合的治疗。患者参与此类研究是非常有益的。

铂类联合依托泊苷是最常用的标准化疗[4][5][6]。[证据等级:1iiA]铂类和非铂类联合化疗、增加剂量或给药频次、改变不同化疗药的给药方式(例如更换或序贯给药)或维持化疗相比,并无一致的生存获益[7][8][9][10][11][12]。[ 证据等级:1iiA​]

放疗

SCLC具有高度放疗敏感性,胸部放疗改善局限期与广泛期患者的生存[13][14][15]。[ 证据等级:1iiA]预防性脑照射可预防中枢神经系统复发,可能改善化疗敏感患者的长期生存率[16][17][18],[ 证据等级:1iiA​]且可能缓解肿瘤转移产生的症状。

局限期、广泛期或复发SCLC患者的治疗总结见表1。

表1. 小细胞肺癌患者的标准治疗选择
表1. 小细胞肺癌患者的标准治疗选择
分期 标准治疗选择
局限期​ 化疗和放疗​
单独联合化疗​
手术后化疗或放化疗​
预防性脑照射​
广泛期 联合化疗​
放疗​
预防性脑照射​
复发 化疗​
姑息治疗​

回顾性研究显示SCLC长期生存者(治疗开始后生存时间>2年)的CNS损害发生率较高[27][30][34][35][36]。前瞻性研究显示与未经治疗的患者相比接受PCI治疗的患者神经心理功能没有明显变差[36]。绝大多数SCLC患者在开始PCI治疗前已经出现神经心理异常,且开始PCI治疗后的整2年里都没有可检测到的神经学状态下降[36]。 SCLC患者在治疗开始2年后神经心理功能会继续下降[34][35][36]在下定论认为PCI不降低智力功能之前,需对治疗开始2年后的患者进行更多的神经心理学检查。

关于正在进行的临床试验信息请访问 NCI网站

参考文献

1. Comis RL, Friedland DM, Good BC: Small-cell lung cancer: a perspective on the past and a preview of the future. Oncology (Huntingt) 12 (1 Suppl 2): 44-50, 1998.[PUBMED Abstract]

2. Agra Y, Pelayo M, Sacristan M, et al.: Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database Syst Rev (4): CD001990, 2003.[PUBMED Abstract]

3. Prasad US, Naylor AR, Walker WS, et al.: Long term survival after pulmonary resection for small cell carcinoma of the lung. Thorax 44 (10): 784-7, 1989.[PUBMED Abstract]

4. Johnson BE, Grayson J, Makuch RW, et al.: Ten-year survival of patients with small-cell lung cancer treated with combination chemotherapy with or without irradiation. J Clin Oncol 8 (3): 396-401, 1990.[PUBMED Abstract]

5. Lassen U, Osterlind K, Hansen M, et al.: Long-term survival in small-cell lung cancer: posttreatment characteristics in patients surviving 5 to 18+ years--an analysis of 1,714 consecutive patients. J Clin Oncol 13 (5): 1215-20, 1995.[PUBMED Abstract]

6. Fry WA, Menck HR, Winchester DP: The National Cancer Data Base report on lung cancer. Cancer 77 (9): 1947-55, 1996.[PUBMED Abstract]

7. Ihde DC, Mulshine JL, Kramer BS, et al.: Prospective randomized comparison of high-dose and standard-dose etoposide and cisplatin chemotherapy in patients with extensive-stage small-cell lung cancer. J Clin Oncol 12 (10): 2022-34, 1994.[PUBMED Abstract]

8. Arriagada R, Le Chevalier T, Pignon JP, et al.: Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer. N Engl J Med 329 (25): 1848-52, 1993.[PUBMED Abstract]

9. Klasa RJ, Murray N, Coldman AJ: Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung. J Clin Oncol 9 (3): 499-508, 1991.[PUBMED Abstract]

10. Elias AD, Ayash L, Frei E 3rd, et al.: Intensive combined modality therapy for limited-stage small-cell lung cancer. J Natl Cancer Inst 85 (7): 559-66, 1993.[PUBMED Abstract]

11. Murray N, Livingston RB, Shepherd FA, et al.: Randomized study of CODE versus alternating CAV/EP for extensive-stage small-cell lung cancer: an Intergroup Study of the National Cancer Institute of Canada Clinical Trials Group and the Southwest Oncology Group. J Clin Oncol 17 (8): 2300-8, 1999.[PUBMED Abstract]

12. Amarasena IU, Walters JA, Wood-Baker R, et al.: Platinum versus non-platinum chemotherapy regimens for small cell lung cancer. Cochrane Database Syst Rev (4): CD006849, 2008.[PUBMED Abstract]

13. Pignon JP, Arriagada R, Ihde DC, et al.: A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327 (23): 1618-24, 1992.[PUBMED Abstract]

14. Warde P, Payne D: Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 10 (6): 890-5, 1992.[PUBMED Abstract]

15. Murray N, Coy P, Pater JL, et al.: Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11 (2): 336-44, 1993.[PUBMED Abstract]

16. Turrisi AT 3rd, Glover DJ: Thoracic radiotherapy variables: influence on local control in small cell lung cancer limited disease. Int J Radiat Oncol Biol Phys 19 (6): 1473-9, 1990.[PUBMED Abstract]

17. Aupérin A, Arriagada R, Pignon JP, et al.: Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 341 (7): 476-84, 1999.[PUBMED Abstract]

18. Slotman B, Faivre-Finn C, Kramer G, et al.: Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 357 (7): 664-72, 2007.[PUBMED Abstract]

上一页   下一页
译文由 中国国家癌症中心提供
本站由 中国医学科学院医学信息研究所创办并维护 未经许可禁止转载或建立镜像