Laurie Scott A, Logan Diane, Markman Barbara R, Mackay Jean A, Evans William K
Ottowa Regional Cancer Centre, Ottawa, ON, Canada.
Lung Cancer. 2004 Feb;43(2):223-40. doi: 10.1016/j.lungcan.2003.09.002.
An evidence-based practice guideline was developed to identify the optimal combination chemotherapy regimen, schedule of administration, and duration of therapy for the first-line treatment of adults with limited-stage small-cell lung cancer. The guideline is based on a systematic search and review of literature published between 1985 and December 2002. Three reviewers selected studies for inclusion in the guideline according to pre-defined criteria. Fifty randomized controlled trials, five in abstract form, were included in the review, and feedback on a draft version of the guideline was obtained from medical oncologists in the province of Ontario, Canada. The most commonly used regimens in clinical trials are cyclophosphamide-doxorubicin(Adriamycin)-vincristine, and etoposide-cisplatin. No combination chemotherapeutic regimen has been conclusively shown to be superior to either of these regimens. Most studies comparing chemoradiation regimens used sequential rather than concurrent thoracic radiotherapy. When treating for cure with chemoradiation, there is evidence from one randomized controlled trial to support the use of etoposide-cisplatin over an anthracycline-containing regimen. There is conflicting evidence concerning a survival advantage for a regimen that alternates cyclophosphamide-doxorubicin-vincristine with etoposide-cisplatin compared with either regimen alone. If bolus etoposide-cisplatin is the treatment of choice, evidence from one randomized trial suggests that the optimal sequence of administration is cisplatin followed by etoposide. The use of maintenance chemotherapy is not indicated. There is insufficient evidence to support the routine use of dose-intensive regimens outside a clinical trial, to determine the optimal duration of chemotherapy, or to support the routine substitution of carboplatin for cisplatin in combination chemotherapy regimens in this patient population.
Etoposide-cisplatin is the preferred chemotherapy regimen for patients with limited-stage small-cell lung cancer when concurrent thoracic radiotherapy is used. It is reasonable to offer the alternation of etoposide-cisplatin with cyclophosphamide-doxorubicin-vincristine, provided the administration of radiotherapy concurrent with an anthracycline is avoided.
制定了一项循证实践指南，以确定用于一线治疗局限性小细胞肺癌成人患者的最佳联合化疗方案、给药时间表和治疗持续时间。该指南基于对1985年至2002年12月发表的文献进行的系统检索和综述。三位评审员根据预先定义的标准选择纳入指南的研究。该综述纳入了50项随机对照试验，其中5项为摘要形式，并从加拿大安大略省的医学肿瘤学家那里获得了关于该指南草案版本的反馈。临床试验中最常用的方案是环磷酰胺-阿霉素（阿霉素）-长春新碱，以及依托泊苷-顺铂。尚无确凿证据表明任何联合化疗方案优于这两种方案中的任何一种。大多数比较放化疗方案的研究采用序贯而非同步胸部放疗。当采用放化疗进行根治性治疗时，一项随机对照试验的证据支持使用依托泊苷-顺铂而非含蒽环类药物的方案。关于环磷酰胺-阿霉素-长春新碱与依托泊苷-顺铂交替使用的方案与单独使用任一方案相比是否具有生存优势，存在相互矛盾的证据。如果大剂量依托泊苷-顺铂是首选治疗方法，一项随机试验的证据表明，最佳给药顺序是顺铂后接依托泊苷。不建议使用维持化疗。没有足够的证据支持在临床试验之外常规使用剂量密集方案、确定化疗的最佳持续时间，或支持在该患者群体的联合化疗方案中常规用卡铂替代顺铂。
对于使用同步胸部放疗的局限性小细胞肺癌患者，依托泊苷-顺铂是首选化疗方案。如果避免放疗与蒽环类药物同时使用，提供依托泊苷-顺铂与环磷酰胺-阿霉素-长春新碱交替使用是合理的。
