Simon George R, Turrisi Andrew
H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-4W, Tampa, FL 33612, USA.
Chest. 2007 Sep;132(3 Suppl):324S-339S. doi: 10.1378/chest.07-1385.
This guideline is for the management of patients with small cell lung cancer (SCLC) and is based on currently available information. As part of the guideline, an evidence-based review of the literature was commissioned that enables the reader to assess the evidence as we have attempted to put the clinical implications into perspective.
We conducted a comprehensive review of the available literature and the previous American College of Chest Physicians guidelines of SCLC. Controversial and less understood areas of the management of SCLC were then subject to an exhaustive review of the literature and detail analyses. Experts in evidence-based analyses compiled the accompanying systematic review titled "Evidence for Management of SCLC." The evidence was then assessed by a panel of experts to incorporate "clinical relevance." The resultant guidelines were then scored according to the grading system outlined by the American College of Chest Physicians grading system task force.
SCLC accounts for 13 to 20% of all lung cancers. Highly smoking related and initially responsive to treatment, it leads to death rapidly in 2 to 4 months without treatment. SCLC is staged as limited-stage and extensive-stage disease. Limited-stage disease is treated with curative intent with chemotherapy and radiation therapy, with approximately 20% of patients achieving a cure. For all patients with limited-stage disease, median survival is 16 to 22 months. Extensive-stage disease is primarily treated with chemotherapy with a high initial response rate of 60 to 70% but with a median survival of 10 months. All patients achieving a complete remission should be offered prophylactic cranial irradiation. Relapsed or refractory SCLC has a uniformly poor prognosis.
In this section, evidence-based guidelines for the staging and treatment of SCLC are outlined. Limited-stage SCLC is treated with curative intent. Extensive-stage SCLC has high initial responses to chemotherapy but with an ultimately dismal prognosis with few survivors beyond 2 years.
本指南旨在指导小细胞肺癌（SCLC）患者的管理，其依据的是当前可得信息。作为该指南的一部分，我们委托开展了一项基于证据的文献综述，以便读者在我们尝试阐述临床意义时能评估相关证据。
我们对现有文献以及美国胸科医师学会之前关于SCLC的指南进行了全面综述。然后，针对SCLC管理中存在争议和理解较少的领域，对文献进行了详尽综述和详细分析。循证分析专家编制了随附的系统综述《小细胞肺癌管理的证据》。随后，由专家小组评估证据以纳入“临床相关性”。最终的指南依据美国胸科医师学会分级系统工作组概述的分级系统进行评分。
SCLC占所有肺癌的13%至20%。它与吸烟高度相关，最初对治疗有反应，若不治疗，2至4个月内会迅速导致死亡。SCLC分为局限期和广泛期疾病。局限期疾病采用化疗和放疗进行根治性治疗，约20%的患者可治愈。所有局限期疾病患者的中位生存期为16至22个月。广泛期疾病主要采用化疗，初始缓解率较高，为60%至70%，但中位生存期为10个月。所有完全缓解的患者均应接受预防性脑照射。复发或难治性SCLC的预后普遍较差。
在本节中，概述了基于证据的SCLC分期和治疗指南。局限期SCLC采用根治性治疗。广泛期SCLC对化疗初始反应较高，但最终预后不佳，2年以上存活者寥寥无几。
