Division of Oncology, National Jewish Health, Denver, CO.
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ.
Chest. 2013 May;143(5 Suppl):e400S-e419S. doi: 10.1378/chest.12-2363.
Small cell lung cancer (SCLC) is a lethal disease for which there have been only small advances in diagnosis and treatment in the past decade. Our goal was to revise the evidence-based guidelines on staging and best available treatment options.
A comprehensive literature search covering 2004 to 2011 was conducted in MEDLINE, Embase, and five Cochrane databases using SCLC terms. This was cross-checked with the authors' own literature searches and knowledge of the literature. Results were limited to research in humans and articles written in English.
The staging classification should include both the old Veterans Administration staging classification of limited stage (LS) and extensive stage (ES), as well as the new seventh edition American Joint Committee on Cancer/International Union Against Cancer staging by TNM. The use of PET scanning is likely to improve the accuracy of staging. Surgery is indicated for carefully selected stage I SCLC. LS disease should be treated with concurrent chemoradiotherapy in patients with good performance status. Thoracic radiotherapy should be administered early in the course of treatment, preferably beginning with cycle 1 or 2 of chemotherapy. Chemotherapy should consist of four cycles of a platinum agent and etoposide. ES disease should be treated primarily with chemotherapy consisting of a platinum agent plus etoposide or irinotecan. Prophylactic cranial irradiation prolongs survival in those individuals with both LS and ES disease who achieve a complete or partial response to initial therapy. To date, no molecularly targeted therapy agent has demonstrated proven efficacy against SCLC.
Evidence-based guidelines are provided for the staging and treatment of SCLC. LS-SCLC is treated with curative intent with 20% to 25% 5-year survival. ES-SCLC is initially responsive to standard treatment, but almost always relapses, with virtually no patients surviving for 5 years. Targeted therapies have no proven efficacy against SCLC.
小细胞肺癌（SCLC）是一种致命的疾病，在过去十年中，其诊断和治疗方面仅取得了微小的进展。我们的目标是修订有关分期和最佳可用治疗选择的循证指南。
在 MEDLINE、Embase 和五个 Cochrane 数据库中，使用 SCLC 术语进行了一项涵盖 2004 年至 2011 年的全面文献检索。这与作者自己的文献检索和对文献的了解进行了交叉核对。结果仅限于人类研究和英文文献。
分期分类应包括旧的退伍军人管理局分期分类的局限性（LS）和广泛性（ES），以及新的第七版美国癌症联合委员会/国际抗癌联盟 TNM 分期。PET 扫描的使用可能会提高分期的准确性。手术适用于精心选择的 I 期 SCLC。对于身体状况良好的 LS 疾病患者，应采用同期放化疗治疗。在治疗过程中应尽早进行胸部放疗，最好在化疗的第 1 或 2 个周期开始时进行。化疗应由铂类药物和依托泊苷组成四个周期。ES 疾病应主要采用含铂类药物加依托泊苷或伊立替康的化疗治疗。预防性颅脑照射可延长对初始治疗有完全或部分反应的 LS 和 ES 疾病患者的生存时间。迄今为止，尚无针对 SCLC 的分子靶向治疗药物被证明有效。
为 SCLC 的分期和治疗提供了循证指南。LS-SCLC 采用治愈性意图治疗，5 年生存率为 20%至 25%。ES-SCLC 最初对标准治疗有反应，但几乎总是复发，几乎没有患者能存活 5 年。靶向治疗对 SCLC 没有明显疗效。
