Ciombor Kristen Keon, Rocha Lima Caio Max S
Department of Medicine, University of Miami and Sylvester Cancer Center, 1475 NW 12th Avenue (D8-4), Miami, FL 33136, USA.
Curr Treat Options Oncol. 2006 Jan;7(1):59-68. doi: 10.1007/s11864-006-0032-7.
Small cell lung cancer (SCLC) is an aggressive type of lung cancer characterized by rapid growth and early metastasis. It is chemosensitive and radiosensitive, yet decades of research investigating multimodality treatments have failed to control or cure this disease in most patients. First-line treatment of limited-stage disease consists of chemotherapy (often etoposide/cisplatin or etoposide/carboplatin) combined with thoracic radiation therapy (TRT), followed by prophylactic cranial irradiation to decrease brain metastases as a site of disease progression for those who experience complete remission or a very good partial response to multimodality treatment. In a Japanese trial, the combination of irinotecan and cisplatin had initially shown promise in treating patients with extensive-stage SCLC, but a confirmatory trial in the United States did not find a difference in overall survival with irinotecan/cisplatin versus etoposide/cisplatin. Adding a third drug to the etoposide/cisplatin combination, as well as other triplet therapies, has mostly been ineffective in improving outcomes. Variables in chemotherapy administration, including maintenance therapy, alternating non-cross-resistance regimens, and dose intensification, have not been shown to increase survival at large. In terms of radiation therapy, early administration of TRT concurrent with chemotherapy, and hyperfractionation, have been beneficial in treatment of limited-stage disease. In patients who relapse, second-line therapy options consist of reinduction of previous chemotherapy or administration of a single agent. Targeted biological therapies for SCLC are now being investigated, and although a great deal of research remains to be done, these agents and their derivatives may provide the most hope for future treatment of SCLC.
小细胞肺癌（SCLC）是一种侵袭性肺癌，其特点是生长迅速且早期转移。它对化疗和放疗敏感，但数十年来对多模式治疗的研究未能在大多数患者中控制或治愈这种疾病。局限期疾病的一线治疗包括化疗（通常是依托泊苷/顺铂或依托泊苷/卡铂）联合胸部放射治疗（TRT），随后对那些对多模式治疗获得完全缓解或非常好的部分缓解的患者进行预防性颅脑照射，以减少脑转移作为疾病进展的部位。在一项日本试验中，伊立替康和顺铂联合用药最初显示出治疗广泛期SCLC患者的前景，但美国的一项验证性试验未发现伊立替康/顺铂与依托泊苷/顺铂在总生存期上有差异。在依托泊苷/顺铂联合方案中添加第三种药物以及其他三联疗法，大多未能有效改善治疗结果。化疗给药方面的变量，包括维持治疗、交替使用非交叉耐药方案和剂量强化，总体上未显示能提高生存率。在放射治疗方面，早期将TRT与化疗同时进行以及超分割放疗，对局限期疾病的治疗有益。对于复发患者，二线治疗方案包括重新诱导使用先前的化疗或给予单一药物。目前正在研究针对SCLC的靶向生物疗法，尽管仍有大量研究有待开展，但这些药物及其衍生物可能为SCLC的未来治疗带来最大希望。
