Podsumowanie

1. U chorych na DKRP istotnym czynnikiem jest prawidłowa ocena stopnia zaawansowania nowotworu, ponieważ parametr ten ma nie tylko znaczenie prognostyczne, ale również jest czynnikiem wpływającym na wybór właściwego postępowania terapeutycznego. W piśmiennictwie proponowane jest zastąpienie klasycznej dwustopniowej klasyfikacji VALSG (dotychczas powszechnie stosowana w klinice i w publikowanych danych literaturowych) klasyfikacją TNM.

2. Podstawową metodą leczenia chorych na DKRP (niezależnie od stopnia zaawansowania nowotworu) jest chemioterapia. Polega ona na podaniu czterech-sześciu cykli według schematów zawierających w składzie cisplatynę. Zalecenie dotyczy wszystkich chorych (niezależnie od wieku), jeżeli ich stan ogólny pozwala na przeprowadzenie takiego leczenia.

3. U chorych na DKRP radioterapia na obszar klatki piersiowej:

A. w przypadku OP powinna być rozpoczynana wcześnie (względem chemioterapii) i prowadzona według schematu przyspieszonej frakcjonacji dawki,

B. w przypadku UP powinna być prowadzona po zakończeniu chemioterapii, po uzyskaniu całkowitej lub częściowej odpowiedzi na leczenie.

4. U chorych na DKRP (zarówno w OP, jak i w UP), u których uzyskano całkowitą lub częściową odpowiedź na leczenie, zalecane jest przeprowadzenie profilaktycznego napromieniania mózgu.

Piśmiennictwo

1. Haddahin S, Perry MC. History of small-cell lung cancer. Clin Lung Cancer 2011; 12(2): 87-93

2. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63: 11-30

3. Jett JR, Schild SE, Kesler KA, Kalemkerian GP. Treatment of small-cell lyng cancer. Diagnosis an management of lung cancer, 3rd ed: American Collegge of Chest Physicans Evidnce-Based Clinical Practice Guidelines. Chest 2013; 143(5): 400-419

4. Goldstraw P, Crowley J, Chansky K, i wsp. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumors. J Thorac Oncol 2007; 2(8): 706-714

5. Stinchcommbe TE, Gore EM. Limited-stage small-cell lung cancer: current chemoradiotherapy treatment paradigms. The Oncologist 2010; 15: 187-195

6. Kallinos A, Rapti A, Zarogoulidis P i wsp. Thearpeutic procedure in small-cell lung cancer. J thorac Dis 2013; 5(4): 420-424

7. Goldberg SB, Willers H, Heist R. Multidisciplinary management of small-cell lung cancer. Surg Oncol Clin N Am 2013; 22: 329-343

8. Fruh M, De Ruysscher D, Popat S i wsp. Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatmnt and foloow-up. Ann Oncol 2010; 21(Suppl 5): 120-125

9. Hochstenbag MMH, Twijnstra A, Wilmink JT i wsp. Asymptomatic brain metastase (BM) in small-cell lung cancer (SCLC): MR-imaging is useful at initial diagnosis. J Neurooncol 200; 48(3): 243-248

10. Seute T, Leffers P, Wilmink JT i wsp. Respose of asymptomatic brain metastases from small-cell lung cancer to systemic first-line chemotherapy. J Clin Oncol 2006; 24(13): 2079-2083

11. Campling B, Quirt I, DeBoer G i wsp. Is bone marrow examination in small-cell lung cancer really necessary? Ann Intern Med. 1986; 105(4): 508-512

12. Tritz DB, Doll DC, Ringenberg QS i wsp. Bone marow involvement in small-cell lung cancer. Clinical significance and correlation with routine labolatory variables. Cancer 1989; 63(4): 763-766

13. Levitan N, Byrne RE, Bromer RH i wsp. The value of the scan and bone marrow biopsy staging small-cell lung cancer. Cancer 1985; 56(3): 652-654

14. Brink I, Schumacher T, Mix M i wsp. Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer. Eur J Nucl Med Mol Imaging 2004; 31(12): 1614-1620

15. Niho S, Fujii H, Murakami K i wsp. Detection of ususpected distant metastases and/or regional nodes by FDG-PET [corrected] scan in apparent limited-disease small-cell lung cancer. Lung Cancer 2007; 57(3): 328-333

16. Baka S, Califano R, Ferraldeschi R i wsp. Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer. Br J Cancer 2008; 99(3): 442-447

17. Lara PN Jr, Natale R, Crowley J i wsp. Phase III trial of irinotecan/cisplatin compared with etopiside/cisplatin in extensive-stage small-cell lung cancer: clinical and pharmacogenomic results from SWOG S0124. J Clin Oncol 2009; 27(15): 2530-2535

18. Amarasena IU, Walters JAE, Wood-Baker R, Fong K. Platinum versus non-platinum chemotherapy regiments for small-cell lung cancer. Cochrane Database Syst Rev 2008; 4; CD006849

19. Owonikoko TK, Ragin CC, Belani CP i wsp. Lung cancer in eldery patients: an analysis of the surveilance, epidemiology, and results database. J Clin Oncol 2007; 25(35): 5570-5577

20. Ardizzoni A, Favaretto A, Boni L i wsp. Platinum-etoposide chemotherapy in eldery patients with small-cell ling cancer: results of a randomozed multicenter phase II study assessing attenuated-dose or full-dose with lenogeastim prophylaxis – a Forza Operativa Nazionale Italiana Carcinoma Polmonare ND Gruppo Studio Tumori Polmonari Veneto (FINICAP-GSTPV) study. J Clin Oncol 2005; 23(3): 569-575

21. Okamoto H, Watanabe K, Kunikane H i wsp. Randomised phase III trial of carboplatin plus etoposide vs split doses of cisplatin plus etoposide in eldery or poor-risk patients with extensive disease small-cell lung cancer: JCOG 9702. Br J Cabcer 2008; 97(2): 162-169

22. Souhami RL, Spiro SG, Rudd RM i wsp. Five-day oral etoposide treatment for advanced small-cell lung cancer: randomized comparison with intravenuos chemotherapy. J Natl Cancer Inst 1997; 89(8): 577-580

23. Pignon JP, Arriagada R, Ihde DC i wsp. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992; 327(23): 1618-1624

24. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 1992; 10 (6): 890-895

25. Fried DB, Morris DE, Poole C. i wsp. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer. J Clin Oncol 2004; 22 (23): 4785-4793

26. Murray N, Coy P, Pater JL. i wsp. Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. J Clin Oncol 1993; 11: 336-344

27. Coy P, Hodson DI, Murray N. i wsp. Patterns of failure following loco-regional radiotherapy in the treatment of limited stage small cell lung cancer. Int J Radiat Oncol Biol Phys 1993; 28: 355-362

28. De Ruysscher D, Pijls-Johannesma M, Bentzen SM. i wsp. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 2006; 27 (7): 1057-1063

29. Paumier A, Le Pechoux C. Radiotherapy in small-cell lung cancer: where should it go? Lung Cancer 2010; 69(2): 133-140

30. Turrisi AT, Kim K, Blum R. i wsp. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 1999; 340: 265-271

31. Le Pechux C, Mauguen A, Schild SE i wsp. Accelerated or hyperfractionated radiotherapy (RT) versus conventional RT in non metastatic lung cancer (LC): individual patient data (IPD) meta-analysis from 2279 patients. J ThoracOncol 2010; 5(suppl 1): 73

32. Choi NC, Herndon JE 2nd, Rosenman J i wsp. Phase I study to determine the maximum-tolerated dose of radiation i standard daily and hyperfractionated-accelerated twice-daily radiation schedules with concurrent chemotherapy for limited-stage small-cell lung cancer. J clin Oncol 1998; 16: 3528-3536

33. Bogart JA, Herndon JE 2 nd, Lyss AP i wsp. 70 Gy thoracic radiotherapy is feasible concurrent with chemotherapy for limited-stage small-cell lung cancer: analysis of Cancer and Leukrmia Broup B Study 39808. Int J Radiat Oncol Biol Phys 2004; 59: 460-468

34. Komaki R, Swann RS, Ettinger DS. i wsp. Phase I study of thoracic radiation dose escalaltion with concurrent chemotherapy for patients with limited small-cell lung cancer: Report of Radiation Therapy Oncology Group (RTOG) Protocol 97-12. Int J radiat oncol Biol Phys 2005; 62: 342-350

35. Schild SE, Stella PJ, Brooks BJ i wsp. Results of combined-modality therapy for limited-stage small-cell lung carcinoma in the eldery. Cancer 2005; 103(11): 2349-2354

36. Hirsch FR, Paulson OB, Hansen HH. i wsp. Intracranial metastases in small-cell carcinoma of the lung: correlation of clinical and autopsy findings. Cancer 1982; 50: 2433-2437

37. Kotalik J, Yu E, Markman BR. i wsp. Practice guideline on prophylactic cranial irradiation in small-cell lung cancer. Int J Radiat Oncol Biol Phys 2001; 50 (2): 309-316

38. Gregor A, Cull A, Stephens RJ. i wsp. Prophylactic cranial irradiation is indicated following complete response to induction therapy in small-cell lung cancer: results of a multicentre randomised trial. Eur J Cancer 1997; 33 (11): 1752-1758

39. Patel S, Macdonald OK, Suntharalingam M. Evaluation of the use of ptophylactic cranial irradiation in small-cell lung cancer. Cancer 2009; 115(4): 842-850

40. Auperin A, Arriagada R, Pignon JP i wsp. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. N Engl J Med 1999; 341: 476-484

41. Frytak S, Shaw JN, O’Neil BO i wsp. Leucoencephalopathy in small-cell lung cancer patients receiving prophylactic cranial irradiation. Am J Clin Oncol 1989; 12(1): 27-33

42. Slotman B, Faivre-Finn C, Kramer G I wsp. EORTC Radiation Oncology Group and Lung Cancer Gtoup. Ptophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 2007; 357(7): 663-672

43. Johnston BE, Becker B, Goff WB II I wsp. Neurologic, neuropsychologic, and computed cranial tomography scan abnormalities in 2- and 10-year survivors of small-cell lung cancer. J Clin Oncol 1985; 3(12): 1659-1667

44. Catane R, Schwade JG, Yarr I i wsp. Follow-up neurological evaluation in patients with small-cell lung carcinoma treated with prophylactic cranial irradiation and chemotherapy. Int J Radiat Oncol Biol Phys 1981; 7(1): 105-109

45. Le Pechoux C, Dunant A, Senan S i wsp. Prophylactic Cranial Irradiation (PCI) Collaborative Group. Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemothreapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomized clinical trial. Lancet Oncol 2009; 10(5): 467-474

Do góry