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[小细胞肺癌]

[Small cell lung cancer].

作者信息

Hoschek Stefan, Hoschek-Risslegger Ursula, Fiegl Michael, Zabernigg August, Pall Georg, Auberger Thomas, Gunsilius Eberhard, Schmid Thomas, Jamnig Herbert, Hilbe Wolfgang

机构信息

Landeskrankenhaus Hochzirl, Abteilung für Innere Medizin, Hochzirl, Osterreich.

出版信息

Wien Klin Wochenschr. 2007;119(23-24):697-710. doi: 10.1007/s00508-007-0913-1.

Abstract

With about 20% of all lung cancers small cell lung cancer (SCLC) represents a major subset of this entity. Although therapeutic improvements did not receive as much attention as in non small cell lung cancer (NSCLC), many small steps of clinical progress have been achieved within the last 20 years. An optimal treatment should be based on an interdisciplinary treatment plan. The standard treatment in localized stages represents combined radiation and chemotherapy. Cisplatin and etoposide are in this concern considered as a gold standard. 3D-planned conformal radiotherapy should start as early as possible and should be applied concomitantly to chemotherapy and in certain cases even in a hyperfractionated treatment protocol. In very early stages surgical resection could be an option in selected cases. In advanced stages a platinum-based doublet offers high response rates. As already established in limited disease prophylactic cranial irradiation is now also indicated in extensive disease in case of any tumor remission. In the second line treatment and in patients with reduced performance status topotecan is recommended. Similar as in NSCLC pemetrexed might become an alternative treatment option in the second line setting. In the field of new targeted therapies bevacizumab achieved the most promising results. The present review highlights historical milestones and up-to-date trends in radiotherapy, chemotherapy and surgery. Furthermore, the role of experimental strategies and the management of certain special clinical situations are discussed.

摘要

小细胞肺癌(SCLC)约占所有肺癌的20%,是这一疾病实体的主要亚型。尽管与非小细胞肺癌(NSCLC)相比,其治疗进展未受到同等程度的关注,但在过去20年里仍取得了许多临床进展的小成就。最佳治疗方案应基于多学科治疗计划。局限期的标准治疗是放疗联合化疗。顺铂和依托泊苷在这方面被视为金标准。三维计划适形放疗应尽早开始,并应与化疗同时进行,在某些情况下甚至采用超分割治疗方案。在极早期,对于部分病例手术切除可能是一种选择。在晚期,含铂双药方案有较高的缓解率。正如在局限期已确立的那样,现在对于广泛期患者,若出现任何肿瘤缓解,也建议进行预防性脑照射。在二线治疗以及体能状态较差的患者中,推荐使用拓扑替康。与NSCLC类似,培美曲塞可能成为二线治疗中的替代治疗选择。在新的靶向治疗领域,贝伐单抗取得了最有前景的结果。本综述重点介绍了放疗、化疗和手术方面的历史里程碑及最新趋势。此外,还讨论了实验策略的作用以及某些特殊临床情况的处理。

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