Small-cell lung cancer: state of the art.
Small-cell lung cancer: state of the art.
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DOI：
10.3816/clc.2002.n.018
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发表时间：
2002-09-01
影响因子：
3.6
通讯作者：
Einhorn, Lawrance H
中科院分区：
文献类型：
--
作者：
Hanna, Nasser H;Einhorn, Lawrance H
30年前，人们对小细胞肺癌（SCLC）的治疗普遍持悲观态度。单独的手术或放射治疗导致很少治愈，因为这些技术利用了对播散性疾病的局部治疗。化疗仍然是所有SCLC患者治疗的支柱，无论分期如何。对于局限期疾病（LD）患者，标准的化疗方案是胸部放疗。放射治疗的最佳时机、剂量和时间表尚未确定。大多数研究表明，与延迟放疗相比，早期放疗的生存率相当或上级。大约50%的LD患者将通过放化疗达到完全缓解，并将成为预防性颅照射（PCI）的候选人。虽然III期临床试验未能证明PCI的生存率具有统计学意义，但脑复发明显减少，荟萃分析报告称接受PCI的患者具有较小的长期生存优势。不幸的是，与LD SCLC不同，尽管测试了许多策略，但广泛期疾病的进展一直难以捉摸。四个疗程的顺铂（或卡铂）加依托泊苷仍然是标准的一线治疗。伊立替康/顺铂的结果令人鼓舞，但仍需要进行验证性试验。化疗方案已经达到了一个平台期，迫切需要新的策略来提高SCLC患者的生存率。
Thirty years ago, there was a pervasive atmosphere of pessimism concerning the management of small-cell lung cancer (SCLC). Surgery or radiation therapy alone resulted in few cures since these techniques utilize a local therapy for a disseminated disease. Chemotherapy remains the backbone of treatment for all patients with SCLC, regardless of stage. For patients with limited-stage disease (LD), the addition of thoracic radiation to chemotherapy is standard. The optimal timing, dose, and schedule of radiation remains undefined. The majority of studies demonstrate equivalent or superior survival for early radiation when compared to delayed radiation. Approximately 50% of patients with LD will achieve a complete remission with chemoradiation and will be candidates for prophylactic cranial irradiation (PCI). While phase III trials have failed to demonstrate a statistically significant survival for PCI, brain relapse is clearly reduced, and a metaanalysis reports a small long-term survival advantage favoring patients receiving PCI. Unfortunately, unlike LD SCLC, advances in extensive-stage disease have been elusive, despite the testing of numerous strategies. Four courses of cisplatin (or carboplatin) plus etoposide remain standard first-line therapy. Promising results have been seen with irinotecan/cisplatin, but confirmatory trials are still needed. A plateau has been reached with chemotherapy regimens, and novel strategies are greatly needed to improve survival for patients with SCLC.