Amarasena Isuru U, Walters Julia A E, Wood-Baker Richard, Fong Kwun
School of Medicine, Faculty of Health Science, University of Tasmania, 43 Collins Street, Hobart, Tasmania, Australia, 2005.
Cochrane Database Syst Rev. 2008 Oct 8(4):CD006849. doi: 10.1002/14651858.CD006849.pub2.
Small cell lung cancer (SCLC) is a very fast growing form of cancer and is characterised by early metastasis. As a result, chemotherapy is the mainstay of treatment. A number of different platinum-based chemotherapy regimens and non-platinum-based chemotherapy regimens have been used for the treatment of SCLC, with varying results. This review was conducted to analyse the data from these trials in order to compare their effectiveness.
To determine the effectiveness of platinum chemotherapy regimens compared with non-platinum chemotherapy regimens in the treatment of SCLC with respect to survival, tumour response, toxicity and quality of life.
We searched the biomedical literature databases CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE and CINAHL from 1966 to April 2007. In addition, we handsearched reference lists from relevant resources.
All randomised controlled trials involving patients with pathologically confirmed (cytological or histological) SCLC and the use of a platinum-based chemotherapy regimen in at least one treatment arm and a non-platinum-based chemotherapy regimen in a separate arm.
Two authors independently assessed search results. We assessed included studies for methodological quality and recorded the following outcome data: survival, tumour response, toxicity and quality of life. We combined the results of the survival, tumour response and toxicity data in a meta-analysis.
A total of 29 trials involving 5530 patients were included in this systematic review. There was no statistically significant difference between treatment groups in terms of survival at 6 months, 12 months and 24 months. There was also no statistically significant difference in terms of overall tumour response. However, platinum-based treatment regimens did have a significantly higher rate of complete response. Platinum-based chemotherapy regimens had significantly higher rates of nausea and vomiting, anaemia and thrombocytopenia toxicity. Three trials presented quality of life data but the data presented were not complete and therefore could not be combined in a meta-analysis.
AUTHORS' CONCLUSIONS: Platinum-based chemotherapy regimens did not offer a statistically significant benefit in survival or overall tumour response compared with non-platinum-based regimens. However, platinum-based chemotherapy regimens did increase complete response rates, at the cost of higher adverse events including nausea and vomiting, anaemia and thrombocytopenia toxicity. These data suggest non-platinum chemotherapy regimens have a more advantageous risk-benefit profile. This systematic review highlights the lack of quality of life data in trials involving chemotherapy treatment for SCLC. With poor long-term survival associated with both treatment groups, the issue of the quality of the survival period takes on even more significance. It would be beneficial for future trials in this area to include a quality of life assessment.
小细胞肺癌（SCLC）是一种生长迅速的癌症，其特点是早期转移。因此，化疗是主要的治疗方法。许多不同的铂类化疗方案和非铂类化疗方案已被用于治疗SCLC，结果各不相同。进行本综述是为了分析这些试验的数据，以比较它们的有效性。
确定铂类化疗方案与非铂类化疗方案在治疗SCLC时在生存、肿瘤反应、毒性和生活质量方面的有效性。
我们检索了生物医学文献数据库CENTRAL（《 Cochr ane图书馆2007年第2期》）、MEDLINE、EMBASE和CINAHL，检索时间为1966年至2007年4月。此外，我们还手工检索了相关资源的参考文献列表。
所有随机对照试验，涉及病理确诊（细胞学或组织学）的SCLC患者，且至少一个治疗组使用铂类化疗方案，另一个独立组使用非铂类化疗方案。
两位作者独立评估检索结果。我们评估纳入研究的方法学质量，并记录以下结局数据：生存、肿瘤反应、毒性和生活质量。我们将生存、肿瘤反应和毒性数据的结果合并进行荟萃分析。
本系统综述共纳入29项试验，涉及5530名患者。治疗组在6个月、12个月和24个月的生存率方面无统计学显著差异。总体肿瘤反应方面也无统计学显著差异。然而，铂类治疗方案的完全缓解率明显更高。铂类化疗方案的恶心、呕吐、贫血和血小板减少毒性发生率明显更高。三项试验提供了生活质量数据，但所提供的数据不完整，因此无法合并进行荟萃分析。
与非铂类方案相比，铂类化疗方案在生存或总体肿瘤反应方面没有统计学显著益处。然而，铂类化疗方案确实提高了完全缓解率，但代价是包括恶心、呕吐、贫血和血小板减少毒性在内的更高不良事件发生率。这些数据表明非铂类化疗方案具有更有利的风险效益比。本系统综述突出了SCLC化疗治疗试验中生活质量数据的缺乏。由于两个治疗组的长期生存率都很低，生存期质量问题就显得更加重要。未来该领域的试验纳入生活质量评估将是有益的。
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