放射治疗对小细胞肺癌预后的影响

目的:综述胸部放疗以及脑预防照射在小细胞肺癌(SCLC)治疗的作用以及对预后的影响.方法:以"小细胞肺癌和放疗"为关键词,检索1992-2009年PubMed以及CNKI期刊全文数据库,共检索到相关文献614篇,以近5年Ⅲ期临床研究和Meta分析为主要入组标准,以符合分析条件的30篇文献进行综述.结果:胸部放疗联合化疗降低局限期SCLC胸部复发率,改善生存,与晚期同步放化疗以及序贯放化疗相比,早期同步放化疗明显提高SCLC的生存率;胸部放疗能减少广泛期SCLC胸部进展的发生,改善生存;脑预防照射减少放化疗有效的SCLC脑转移事件的发生,提高生存率.结论:胸部放疗以及脑预防照射是提高SCLC生存率的治疗手段,是影响预后的重要治疗因素.     

广泛期小细胞肺癌放射治疗进展

广泛期小细胞肺癌（extensive-stage small cell lung cancer，ES-SCLC）约占小细胞肺癌（（small cell lung cancer，SCLC）的2/3，治疗以化疗为主，辅以放疗等综合治疗。虽然SCLC对放化疗反应敏感、初治缓解率高，但几乎所有ES-SCLC都会发生复发及进展，迫切需要新的治疗策略以提高疗效。近年来，放疗在ES-SCLC中进展主要包括脑预防照射（prophylactic cranial irradiation，PCI）和胸部放疗（thoracic radiotherapy，TRT）。此外，免疫检查点抑制剂展现了良好的抗肿瘤活性，有望成为该领域治疗的重要突破口。本文将对ES-SCLC在放疗和免疫治疗以及其他治疗的临床研究进展方面进行综述。      

局限期小细胞肺癌的放射治疗现状和展望

目的:通过复习局限期小细胞肺癌(SCLC)放射治疗的文献,探讨局限期SCLC最佳放射治疗策略.方法:应用计算机检索PubMed和CHKD数据库有关SCLC放射治疗的70篇研究文章,纳入分析39篇,检索词为小细胞肺癌、局限期、放射治疗和预防性脑照射.结果:试验表明放射治疗优于手术治疗,中位总生存期手术组为6个月,放疗组为10个月,差异有统计学意义;Meta分析显示,联合化疗+放疗较单纯联合化疗方法改善了生存期,单纯联合化疗组患者3年生存率为8.9%,联合化疗+放疗组3年生存率为14.3%,P=0.001.预防性脑照射(PCI)的作用已肯定.但是,胸部照射(thoracic radiation therapy, TRT)的剂量、时机和靶体积等问题未完全解决.结论:局限期SCLC的治疗策略为化疗和同步TRT以及预防性脑照射(PCI).胸部照射应该在化疗早期(化疗第1或2个周期)进行,不赞同根据化疗前肿瘤体积来确定照射靶区. PCI应尽可能在化疗完成后就开始.     

小细胞肺癌诊断与治疗

近几年国内外学者在小细胞肺癌(SCLC)的诊断分期、化放疗顺序、放疗参与综合治疗时间以及新的化疗药物、靶向药物应用等方面进行了广泛研究,尤其在广泛期SCLC化疗缓解后行脑预防照射的研究、新的化疗药物如伊立替康、口服拓扑替康、培美曲塞的应用等方面进行了有益的探索.但在有关分期、局限期SCLC化放疗时间等问题尚有争议,需进一步探讨和研究.     

放射治疗在小细胞未分化肺癌治疗中的作用

小细胞未分化肺癌(简称SCLC)对放化疗的敏感性与其它类型肺癌不同。通常采用3～4种化疗药物联合应用并加胸部放疗,对局限期病例可提高生存率,广泛期病例可有较好的姑息作用。近年来,国内外很多学者对局限期和广泛期Sclc治疗中胸部照射的作用,预防性全脑照射,大面积照射是否必要进行了探讨,期望能够提高疗效。     

海马区保护治疗小细胞肺癌全脑照射的研究进展

小细胞肺癌(SCLC)患者中约15%~20%初诊时已有脑转移,超过80%的患者最终会发展成为脑转移。全脑放疗(WBRT)是肺癌脑转移的标准治疗。全脑预防性照射(PCI)是预防SCLC脑转移的有效治疗手段。随着治疗技术的提高和治疗手段的规范,SCLC患者生存期的延长,采用螺旋断层放疗(TOMO)技术海马保护的WBRT用于PCI或脑转移患者,能够降低神经认知功能损伤,提高患者生活质量。     

SCLC脑预防照射——争议中的进展

SCLC是一种强侵袭性的恶性肿瘤,自然病程短,易发生脑转移,因此在放化疗基础上,应用脑预防照射对于减少脑转移的发生及提高患者生存具有重要意义。然而近年来关于脑预防照射的适应证及应用价值却争议不断。这些争议主要集中在广泛期SCLC中脑预防照射的价值,局限期SCLC中脑预防照射适应证以及是否另有替代方法等。本文旨在对现阶段脑预防照射临床应用的相关争议及进展进行相应探讨。     

局限期小细胞肺癌胸部放疗剂量和分割方式研究进展

目前手术、全身化疗、胸部放疗及预防性脑照射的综合治疗已成为局限期小细胞肺癌的治疗共识。近几十年,药物治疗没有明显突破。在放疗方面,放疗加入的时机、靶区范围、剂量分割方式,以及预防性脑照射等是研究的热点问题。本文对局限期小细胞肺癌胸部放疗剂量和分割方式的研究进展展开简要分析。     

现代诊疗技术下脑预防照射在局限期小细胞肺癌中的疗效分析

目的:探讨现代综合治疗模式及诊断技术下,局限期小细胞肺癌(SCLC)放化疗有效者行脑预防照射(PCI)的疗效及复发失败模式。方法:回顾性分析2006—2014年间共201例于中国医学科学院肿瘤医院接受放化疗综合治疗且达有效[完全缓解(CR)/部分缓解(PR)]的局限期SCLC患者的临床资料。综合治疗采用以调强放疗和≥4...     

广泛期小细胞肺癌放射治疗研究进展

胸部放疗和预防性脑照射在局限期小细胞肺癌治疗中占有重要的地位和作用，使总生存有大幅度提高。本文回顾近几年国内外关于其在广泛期小细胞肺癌治疗中的作用，对其作一综述，以便为临床实际工作提供借鉴和下一步研究提供参考。     

小细胞肺癌放射治疗进展

目的 放射治疗是小细胞肺癌治疗的主要方式,其实施过程涉及到小细胞肺癌的诸多环节,总结国内外关于小细胞肺癌放射治疗的研究现状,探讨胸部放射治疗和全脑预防性照射在小细胞肺癌治疗中的价值.方法 应用PubMed、西文生物医学期刊文献数据库、中国知网及万方期刊全文数据库检索系统,以"小细胞肺癌,放疗,全脑预防性照射"为中文关键词,以"small cell lung cancer,radiotherapy,prophylactic cranial irradiation"为英文关键词,联合检索1996-01-2016-12的相关文献.共检索到英文文献377篇,中文文献4篇.纳入标准:(1)小细胞肺癌;(2)放疗;(3)全脑预防性照射.排除标准:(1)非小细胞肺癌;(2)手术;(3)化疗.根据剔除标准剔除中文文献2条,英文文献326条,最后纳入分析37篇文献.结果局限期小细胞肺癌的胸部放疗的分割剂量和模式为45 Gy/30次,超分割放疗或60~70 Gy/30~35次,常规分割放疗.胸部放疗参与的最佳时间为于化疗第1个周期或第2个周期参与.胸部同步放化疗结束以后行全脑预防性照射,放疗期间可给予药物盐酸美金刚以保护神经认知功能或海马保护的调强放射治疗;广泛期小细胞肺癌的胸部放疗的分割剂量和模式为30 Gy/10次或45 Gy/15次.全脑预防性照射存在争议.结论胸部放射治疗和全脑预防性照射在小细胞肺癌治疗中起着非常重要的作用.     

Improved local control of thoracic disease in small cell lung cancer with higher dose thoracic irradiation and cyclic chemotherapy

Over the past decade, improvement in survival has developed for patients with small cell lung carcinoma (SCLC) due to treatment strategies that include: cyclic combination chemotherapy, thoracic irradiation, and prophylactic cranial irradiation. In this study, we assess the outcome of treatment with initial cyclic combination chemotherapy including: cyclophosphamide, VP 16-123 and methotrexate combined with radiotherapy (RT), 6000 cGY [corrected] to the thorax for patients with limited disease and 3000 cGy [corrected] for patients with extensive disease. Forty-six patients are evaluated: 26 patients with limited disease and 20 with extensive disease. In patients who received 6000 cGy [corrected], to thoracic lesions, in combination with chemotherapy, administered for 3 courses prior to and following RT, the rate of clinically detected failure in the thorax was 3.8%. Morbidity was considered acceptable, although the occurrence of encephalopathy in 6 of 19 cases who received cranial irradiation, 3000 cGy [corrected], and concomitant chemotherapy was a serious consequence. Control of the primary tumor achieved by the use of higher dose RT is shown to be superior to that observed at lower doses of RT. This suggests that for the small cohort of patients whose disease is truly limited at the time of diagnosis, therapeutic regimens, which include higher dose RT, could increase the number of long term survivors of SCLC.     

Recent developments in radiotherapy for small-cell lung cancer: a review by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

Small-cell lung cancer (SCLC) accounts for 13% of all lung tumours. The standard treatment in patients with limited-stage disease is radiotherapy combined with chemotherapy. In extensive SCLC, the importance of consolidation thoracic radiotherapy in patients with a good treatment response has become increasingly recognized. In both limited and extensive disease, prophylactic cranial irradiation is recommended in patients who respond to treatment. New therapeutic approaches such as immunotherapy are being increasingly incorporated into the treatment of SCLC, although more slowly than in non-small cell lung cancer (NSCLC). Diverse radiation dose and fractionation schemes, administered in varying combinations with these new drugs, are being investigated. In the present study we review and update the role of radiotherapy in the treatment of SCLC. We also discuss the main clinical trials currently underway in order to identify future trends.     

Late toxicities and complications in three-year survivors of small cell lung cancer

123 patients with small cell lung cancer (SCLC) presented to the National Cancer Center Hospital (Tokyo) between 1978 and 1986. 22 of 71 patients with limited stage disease (LD) and none of 52 patients with extensive disease (ED) survived for 3 years. 15 of the 22 three year survivors had significant late complications. All patients received chemotherapy and either thoracic irradiation, resection or both. No prophylactic cranial irradiation was given. 4 patients developed cardiac failure, 2 with a dilated cardiomyopathy, despite the fact that no patient received over 420 mg/m² of doxorubicin. 12 patients of the 17 who received thoracic irradiation developed radiation pneumonitis and 3 required hospitalisation for severe haemoptysis (2) or cavity formation (1). 1 patient who received nimustine developed a fatal myelodysplastic syndrome and 2 additional patients developed second primary tumours in the oesophagus (1) and stomach (1). Mild peripheral neuropathy (WHO grade 1) was persistent in 3 patients and asymptomatic azotemia (WHO grade 1) in 7. Despite advances in the treatment of SCLC there are very few asymptomatic long-term survivors.     

Small Cell Lung Cancer: Past,Present, and Future

Small cell lung cancer (SCLC) accounts for about 10% to 15% of all lung cancers. It is characterized by its rapid doubling time, high rate of dissemination, and increased sensitivity to chemotherapy and radiation. Although the incidence of SCLC has been steadily decreasing over time, it remains a serious public health problem given its aggressive clinical behavior and the lack of effective therapies. This review looks at the evolution of SCLC treatment and the standard treatments that are currently available, including platinum-based combination chemotherapy, hyperfractionated thoracic radiation, and prophylactic cranial irradiation. The development of novel therapies for SCLC has been lagging behind, but completed clinical trials and ongoing investigations are helping us define what will be the best therapeutic targets for this disease.     

Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline

PurposeSeveral sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC.MethodsThe American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength.ResultsThe task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy.ConclusionsRT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.     

An Overview of the Role of Radiotherapy in the Treatment of Small Cell Lung Cancer – A Mainstay of Treatment or a Modality in Decline?

AimsSmall cell lung cancer (SCLC) accounts for about 15% of all lung cancers. Chemotherapy, immunotherapy and radiotherapy all play important roles in the management of SCLC. The aim of this study was to provide a comprehensive overview of the role and evidence of radiotherapy in the cure and palliation of SCLC.Materials and methodsThe search strategy included a search of the PubMed database, hand searches, reference lists of relevant review articles and relevant published abstracts. ClinicalTrials.gov was also queried for relevant trials.ResultsThoracic radiotherapy improves overall survival in limited stage SCLC, but the timing and dose remain controversial. The role of thoracic radiotherapy in extensive stage SCLC with immunotherapy is the subject of several ongoing trials. Current evidence supports the use of prophylactic cranial irradiation (PCI) for limited stage SCLC but the evidence is equivocal in extensive stage SCLC. Whole brain radiotherapy is well established for the treatment of brain metastases but evidence is rapidly accumulating for the use of stereotactic radiosurgery. Further studies will define the role of PCI, whole brain radiotherapy and hippocampal avoidant PCI in the immunotherapy era.ConclusionRadiotherapy is an essential component in the multimodality management of SCLC. Technological advances have allowed safer delivery of radiotherapy with reduced toxicities. Discussion at multidisciplinary team meetings is important to ensure radiotherapy is considered and offered in appropriate patients.     

Current perspectives in the management of small cell lung cancer

Considerable progress has been made within the last decade in the management of small cell lung cancer (SCLC) resulting in prolongation of median survival by 4 to 5 times (about 14 and 9 months in limited and extensive disease, respectively), improved quality of life, and an increase of cure rates in 15 approximately 20% of the patients with limited disease. In this review, we are focusing on the details in update treatment schedules of combination chemotherapy against SCLC, prognostic features and staging of SCLC, the role of non-cross resistant alternating chemotherapy, radiotherapy to the primary site including hilar and mediastinal lymph nodes, prophylactic cranial irradiation and surgery in the treatment of SCLC, as well as the complications of treatment.