SCLC小细胞肺癌精编PPT课件.pptVIP

PCI在SCLC中NCCN指南 PCI在诱导化疗达完全缓解的局限期SCLC可减低死亡和脑转移（证据级别：1级） PCI在广泛期治疗有效的SCLC也被推荐（证据级别:1级) 高剂量PCI并没有减少脑转移，反而更多病人因胸部复发及疾病进展死亡。 目前推荐PCI到标准剂量仍为25Gy。 总结 局限期 T1-2,N0 手术治疗 术前需仔细评估 其它 同步放化疗 标准方案：EP IP? 放疗时机 广泛期 方案 EP IP PCI 局限期及广泛期均获益 巩固治疗 化疗与IFN-a 靶向治疗 无阳性结果 二线治疗 伊立替康 拓扑替康 PET-CT 预测预后 Metastatic (extensive-stage) disease is present at diagnosis in most patients with SCLC. Thus, survival is usually not affected by small changes in the amount of locoregional tumour involvement, as it is for NSCLC. Thus, although relevant, the detailed TNM staging previously described (which is more appropriate when surgery is being considered) is not commonly employed for staging SCLC. Instead, a simplified staging system of ‘limited’ versus ‘extensive’ disease is used.1 Approximately one-third of patients with SCLC present with limited-stage disease.2 In limited-stage disease, the tumour is confined to the hemithorax of origin, the mediastinum and the supraclavicular nodes, which can be encompassed within a ‘tolerable radiation’ therapy port.3 The extensive stage of SCLC encompasses any tumour too widespread to be included within the definition of limited stage and any patients with distant metastasis.3 Patients with limited disease have a median survival of 3 months without drug therapy, compared with 1.5 months for patients with extensive disease.2 References PDQ Treatment Guidelines 2000. Kelly K. Chest 2000; 117 (4 Suppl 1): 156S-162S. Zelen M. Cancer Chemother Rep 3 1973; 4: 31-42. 1999年一项me ta分析荟萃了7项临床试验共987例化疗后完全缓解的局限期小细胞肺癌病人进行预防性脑照射。 EP与CAV交叉二线治疗 Topotecan单药二线治疗 Topotecan对照CAV Topotecan+ DDP二线治疗 EP与CAV交叉二线治疗SCLC 对象：一线采用EP或CAV化疗后复发的SCLC 274例。 完成诱导化疗 疾病复发影像学证据 PS≤3 年龄≤75岁 能耐受进一步化疗 108例接受交叉方案 166例未接受二线治疗 治疗措施 EP： VP－16 100mg/m2 +DDP 75mg/m2 D1; Vp16 200mg oral, D2-4 CAV: CTX 1g/m2,VCR 2mg,ADM 50