Tuesday, January 13, 2009

Small cell lung cancer (SCLC) treatment

Following the recommended treatment is based on the U.S. National Cancer Institute and Clinical Center, O-mei proposed treatment.

In determining the treatment plan, the tumor staging and histologic classification is a very important factor, because the majority of patients already diagnosed and obvious potential transfer. In the difference between the smaller stages, the survival was no significant difference, therefore, small-cell lung cancer patient's actual treatment, do not use the past referred to the complexity of the TNM staging system, most commonly used is filled with period and limited hours period, but the stages were difficult to determine the justice, are of the view that limited small cell carcinoma refers to tumors confined to the organ side of the chest, mediastinal and supraclavicular lymph node, and diffuse tumor futures extensive, beyond the limited definition of the above the scope of such patients are often accompanied by distant metastasis.

Limited SCLC

Only 1 / 3 of the patients in the time of diagnosis is limited and chemotherapy for limited SCLC is the principal means.

Chemotherapy with cytotoxic substances in different cell division cycle, such as: VCR to stop the formation of microtubules, adriamycin prevent DNA and RNA synthesis, these drugs, the role of goals in the process of cell division, so fast split cells greater impact than other cells, because cancer cells are rapidly dividing cells, they are subject to the influence of drugs than normal cells, to a large, this feature also explains the side effects, such as chemotherapy-induced hair loss and bone marrow transplant.

Complete remission patients after treatment for 2 years there are still 35% to 65% of the lesions involving the central nervous system (CNS), therefore, to alleviate the patients often take preventive brain irradiation (PCI), but much remains to be further PCI study of neural toxicity to confirm the survival of the period of its advantages.

Treatment options

1. One of the following programs can be combined with chemotherapy and chest radiotherapy

o EC: etoposide + cisplatin + 4000-4500 cGy chest radiation therapy

o ECV: etoposide, cisplatin + vincristine + 4500cGy chest radiotherapy

Complete remission of patients should also be given to preventive brain irradiation (PCI) in order to prevent the transfer of CNS.

1. There are effects of damage or poor lung function of patients, combined with chemotherapy (do or do not PCI).

Of highly selective cases, chemotherapy or chemotherapy plus chest radiotherapy after surgical resection line (do or do not PCI).

Ongoing program of new drugs, different doses, the primary tumor surgically removed, the new radiation therapy programs and technologies, as well as the timing of radiation therapy research, including NSCLC and SCLC immune therapeutic use, there is currently no effective found. The use of autologous bone marrow transplantation has studied high-dose chemotherapy for many years, but almost did not demonstrate that extended the survival time. With the biological characteristics of small cell carcinoma of understanding of the gradual increase, will find a new factor, autocrine growth factor and its receptor, interferon, such as the role will be further studied.

Lung cancer patients with poor survival, and the need for new treatment options, making a large number of patients to join clinical trials group and the use of unconfirmed drugs, in clinical studies, with particular attention to the following questions: in the use of unconfirmed drug treatment , taking into account the ethical issues; and recommended before the experimental treatment, taking into account the likely increase the suffering of patients.

Filled with a view to SCLC

Filled with a view to the patient's chemotherapy patients is similar to limited use, and by the extensive transfer of chest radiotherapy seldom used.

Treatment programs

1. Documents reportedly one of the following programs combined with chemotherapy (do or do not PCI) have better efficacy, and survival is similar.

CAV: cyclophosphamide + doxorubicin + vincristine

CAE: cyclophosphamide + doxorubicin + etoposide

EP or EC: etoposide, cisplatin or carboplatin

ICE: ifosfamide + carboplatin + etoposide

1. Chemotherapy can not immediately ease the transfer of parts, especially the brain, epidural and bone metastases, radiotherapy needed.

Second-line treatment for relapse in patients with a slight survival benefit.

In Taxol (paclitaxel) research, topoisomerase I inhibitor (irinotecan), vinorelbine and gemcitabine as a new agent is currently being used and added to the new program, it seems to help to prolong survival period, different doses of clinical research and high-dose chemotherapy are also being used.

Of high-risk patients, in the past, with or without a history of tumor, and used to prevent the occurrence of cancer preventive chemotherapy, in the absence of a history of cancer patients with β-carotene or vitamin A, no apparent benefits of preventive treatment. Second primary tumor on the incidence of vitamin A, β-carotene may reduce the occurrence of further research will produce more results.

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