Kurup Anupama, Hanna Nasser H
Department of Medicine, Hematology/Oncology, Indiana University, Indianapolis, IN, USA.
Crit Rev Oncol Hematol. 2004 Nov;52(2):117-26. doi: 10.1016/j.critrevonc.2004.08.005.
The incidence of small cell lung cancer (SCLC) is declining in the United States (US). SCLC is nearly universally smoking-related and is very sensitive to both chemotherapy and radiation therapy. In contrast to non-small cell lung cancer (NSCLC), SCLC is staged as either limited-stage disease (LD) or extensive-stage disease (ED). Chemotherapy remains the essential component for treatment of all patients with SCLC, regardless of stage or performance status. In LD, the addition of radiation therapy improves survival over chemotherapy alone. However, the dose, timing and schedule of radiation are not well defined. Prophylactic cranial irradiation (PCI) reduces brain relapse rates, and modestly improves survival in patients in a clinical remission. Many chemotherapy agents and combinations result in high response rates in ED SCLC; however, median survival time remains 8-10 months. Cisplatin (or carboplatin) and etoposide is the standard doublet used in the United States. One study has shown cisplatin plus irinotecan to have a survival benefit over cisplatin plus etoposide, but confirmatory studies are needed. Patients with ED frequently relapse, and relapsed/refractory SCLC has a poor prognosis. The challenge remains to identify novel therapies and molecular targets to improve survival in SCLC.
在美国，小细胞肺癌（SCLC）的发病率正在下降。SCLC几乎普遍与吸烟相关，并且对化疗和放射治疗都非常敏感。与非小细胞肺癌（NSCLC）不同，SCLC分为局限期疾病（LD）或广泛期疾病（ED）。化疗仍然是所有SCLC患者治疗的重要组成部分，无论其分期或身体状况如何。在LD中，加用放射治疗比单纯化疗能提高生存率。然而，放射治疗的剂量、时机和方案尚未明确界定。预防性颅脑照射（PCI）可降低脑转移率，并适度提高临床缓解患者的生存率。许多化疗药物及其联合方案在ED SCLC中可产生较高的缓解率；然而，中位生存时间仍为8至10个月。顺铂（或卡铂）和依托泊苷是美国使用的标准双联方案。一项研究表明，顺铂加伊立替康比顺铂加依托泊苷具有生存优势，但仍需进行验证性研究。ED患者经常复发，复发/难治性SCLC的预后较差。确定新的治疗方法和分子靶点以提高SCLC患者的生存率仍然是一项挑战。
