小细胞肺癌的治疗进展与现状

肺癌为一种恶性程度较高的肿瘤性疾病,其病死率居各种恶性肿瘤之首,发病率逐年上升,近年随着禁烟教育力度的增强和普及,发病率已出现下降势头。小细胞肺癌(SCLC)是一种以生长迅速、早期转移、高度侵袭性为特点的肺癌类型。小细胞肺癌的肿瘤细胞对化疗和放疗都非常敏感,但几十年来多方案的临床试验并没能找到彻底治愈小细胞肺癌的有效方法,多数患者在一线治疗以后仍会复发或转移。局限期小细胞肺癌的一线治疗包括双药化疗(足量EP方案:依托泊甙 顺铂/卡铂)联合胸腔放射治疗(TRT)。当联合方案达完全缓解(CR)或疗效较好的部分缓解(PR)患者,应后续应用预防性脑照射(PCI),可明显降低未来复发性脑转移的风险。日本和德国的临床研究显示含有伊立替康的IP方案及IC方案(伊立替康 顺铂/卡铂)治疗广泛期小细胞肺癌效果可比标准EP方案。各种强化疗法并不能提高小细胞肺癌患者的生存率。胸腔放疗方案的研究显示局限期小细胞肺癌患者早期同步应用超分割放疗方案配合化疗可以改善预后,可能与放疗越早介入越能有效减少耐药克隆株的发生有关。对于小细胞肺癌复发患者,可依据是敏感复发或是难治复发相应选择再次应用首次化疗方案或用二线单药化疗方案。培美曲塞联合铂类方案已应用于SCLC的一线及二线治疗。PET-CT的应用对小细胞肺癌的精确分期非常重要。真正符合Ⅰ_A期及Ⅰ_B期(TNM分期)的小细胞肺癌患者可考虑手术治疗,术后应行正规化疗。生物靶向治疗小细胞肺癌的若干研究性试验正在进行之中,这些生物制剂及其衍生物有可能会为未来小细胞肺癌的治疗带来一线曙光。

Management of small cell lung cancer

Small cell lung cancer (SCLC) is an aggressive type of lung cancer characterized by rap- id growth and early metastasis.It is chemosensitive and radiosensitive,yet decades of research investiga- ting muhimodality treatments have failed to control or cure this disease in most patients.First-line treat- ment of limited-stage disease consists of chemotherapy (often etoposide/cisplatin or etoposide/carbopla- tin) combined with thoracic radiation therapy (TRT),followed by prophylactic cranial irradiation to de- crease brain metastases as a site of disease progression for those who experience complete remission or a very good partial response to multimodality treatment.Japanese and German trials show that the combina- tion of irinotecan and platinum had initially shown promise in treating patients with extensive-stage SCLC.Adding a third drug to the etoposide/cisplatin combination,as well as other triplet therapies,has mostly been ineffective in improving outcomes.Variables in chemotherapy have not been shown to in- crease survival at large.In terms of radiation therapy,early administration of TRT concurrent with chem- otherapy,and hyperfractionation,have been beneficial in treatment of limited - stage disease,perhaps it prevents the growth of those chemo-resistant cancer stem cell clones.In patients who relapse,second- line therapy options consist of reinduction of previous chemotherapy or administration of a single agent. There are evidences supporting pemetrexed plus cisplatin to be the standard chemotherapy for all the SCLC.PET-CT is crucial for accuracy in SCLC grading.Those who are real TNM Ia and Ib should take surgery as the first choice.Targeted biology therapies for SCLC are now being investigated,and although a great deal of research remains to be done,these agents and their derivatives may provide the most hope for future treatment of SCLC.