Onkológia 5/2013
Treatment of inicially metastatic small-cell lung cancer
Lung cancer (LC) is the most common cause of death associated with neoplasms. The incidence of LC in 2007 was 71,3/100000 men and 18,6/100000 women in Slovakia. Small-cell lung cancer (SCLC) includes 15–18% of all cases. The diagnosis of LC is based on patient‘ s history, physical examination, basic laboratory tests, x-ray imaging and computed tomography (CT) imaging and histology. The material required for histology can be obtained by means of endoscopy or surgery. Ultrasonography (USG) and/or CT of abdomen is commonly performed as a part of staging process, along with CT or MRI of brain. Bone scan is performed in case of suspicion of bone involvement. According to TNM classification, 7th edition, the same classification can be used for SCLC and non-small cell lung cancer (NSCLC). Chemotherapy and radiotherapy are available for treatment of initially metastatic SCLC. First-line chemotherapy regimen should be based on combination of cisplatin or carboplatin with etoposide (PE). Alternatively, CAV regimen (cyclophosphamide, doxorubicin, vincristine) can be used. Newer regimens did not provide benefit when compared to standard regimens. If progression occurs later than 3 months after finishing first-line chemotherapy, the same regimen may be used in second-line chemotherapy. If progression occurs earlier than 3 months after finishing first-line chemotherapy, topotecan-based regimen is an option for second-line line chemotherapy. Despite promising outcomes of amrubicin-based second-line chemotherapy in Japan, amrubicin is not available in countries of EU. Standard therapy schedules do not include radiotherapy targeted on primary tumor and affected lymph-nodes. According to American and European guidelines, prophylactic cranial irradiation is recommended for patients with extensive disease – SCLC with good performance status after achieving complete or partial response to first-line chemotherapy.
Keywords: small-cell lung cancer, extensive disease, platinum-based regimen, topotecan, amrubicin, prophylactic cranial irradiation.
