局限期小细胞肺癌(SCLC)患者的标准治疗选择

局限期SCLC​患者的标准治疗选择包括:

化疗联合放疗

依托泊苷联合顺铂加胸部放疗(TRT)的联合治疗方法是局限期(LD)SCLC患者最常用的治疗。

单独联合化疗

有放疗禁忌证的患者可仅接受化疗。出现上腔静脉综合征的患者可根据症状严重度立即选择联合化疗、放疗或二者[21][22]。(更多信息请参考PDQ总结 心肺综合征​。)

手术加化疗或放化疗

手术对治疗SCLC患者的作用尚未肯定。一些小型病例分析研究与人群研究报道了少数非常局限的肿瘤:局限于原发肺的小肿瘤或经手术加辅助化疗的局限于肺和同侧肺门淋巴结的患者预后较佳[23][24][25][26][27]。[ 证据等级:3iiiDii]先经手术然后才确认的SCLC患者通常接受辅助化疗,伴或不伴放疗。对于已经接受了放化疗的患者手术不增加生存获益[27]。[ 证据等级:3iiiDii]因缺乏随机临床试验证据,讨论手术对单个SCLC患者的作用时必须考虑到手术的潜在获益及其风险。

预防性脑照射

达到完全缓解的患者可考虑接受PCI。肿瘤控制在脑外范围的患者在开始治疗后2-3年内发生中枢神经系统(CNS)转移的风险为60%[27][29][30]。其中绝大多数患者仅有脑部转移复发,几乎所有CNS复发患者均死于脑转移。PCI可使CNS转移的风险降低超过50%[29]

神经后遗症

环磷酰胺+阿霉素+依托泊苷+长春新碱

老年患者的治疗选择

针对老年患者的最佳治疗方式尚不明确。一项人群分析显示年龄增加与身体状评分下降、合并症增多相关[37]。老年患者接受联合放化疗、强化化疗与PCI的可能性较小。老年患者经治疗后缓解几率更小,而生存预后通常更差。但该现象与年龄相关,还是与年龄相关的合并症或次优治疗相关尚不明确。

目前尚无已发表的专门针对局限期 SCLC老年患者开展的III期临床试验,但已发表的2个协作组研究中共3项次要分析评估了年龄大于等于70岁老年患者的结果[38][39][40]。两项研究均发现老年患者的生存结果与年轻患者相同。但与年轻患者相比,老年患者的毒性反应发生率较高,尤其是血液学毒性反应。 EST-3588试验比较了依托泊苷联合顺铂加每日一次或每日两次放疗的效果,发现老年患者的治疗相关死亡率显著升高(年龄<70岁患者为1%,年龄≥70岁患者为10%;P=0.01)[39]。因为该III期临床试验纳入的老年患者可能并非普通人群中局限期 SCLC患者的典型代表,故将这些结果推广至普通老年人群必须慎重。

处于临床评估阶段的治疗方法

处于临床评估阶段的局限期 SCLC患者的治疗方法包括:

新药治疗。

原发肿瘤手术切除。

新放疗方案与技术(例如,治疗时机,三维治疗计划与剂量分割)。

目前开展的临床研究

从招募 局限期小细胞肺癌患者的NCI癌症临床研究目录中可以筛选美国临床研究。还可以根据部位、药物、干预方法或其他标准进行筛选。

NCI网站提供关于临床研究的基本信息。 

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