一例廣泛期小細胞肺癌的循證治療_《中國循證醫學雜志》

作者：

米登海 ^1,2 , 姜雷 ¹ ,  楊克虎 ¹ , 鄭彤 ²

1. 蘭州大學循證醫學中心，蘭州大學基礎醫學院（蘭州 730000）；2. 甘肅省第二人民醫院腫瘤治療中心 (蘭州 730000);

關鍵詞：

廣泛期小細胞肺癌化療放療循證治療

DOI：

10.7507/1672-2531.20090089

視頻：

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目的針對一例廣泛期小細胞肺癌合并惡性胸水、肝轉移的治療問題，檢索當前最佳臨床證據，為患者
惡性胸水的對癥治療和后續化療方案提供依據。
方法　根據循證臨床實踐的PICO 原則，提出問題，檢索證據，對所獲證據進行質量評價，并結合患者意愿制定治療方案。
結果　共納入10 個隨機對照試驗，13 個系統評價/Meta 分析和3 篇臨床指南。證據結果表明：化療能提高廣泛期小細胞肺癌患者的生存率，艾迪注射液可以減輕放化療所致的不良反應，提高患者的生存質量。EP 方案是小細胞肺癌化療最主要的標準化療方案。結合患者情況，我們采用胸腔閉式引流術加經胸膜腔內注入博來霉素，待患者病情好轉后，采用EP 方案化療，患者生存期要比廣泛期小細胞肺癌的平均存活期長，生活質量得以提高，家屬對治療滿意。
結論　廣泛期小細胞肺癌患者以化療為主，同時輔以對癥、支持治療，預防性頭顱照射（PCI）可以減少腦轉移的發生并提高患者生存率。

引用本文： 米登海,姜雷,楊克虎,鄭彤. 一例廣泛期小細胞肺癌的循證治療. 中國循證醫學雜志, 2009, 09(4): 484-488. doi: 10.7507/1672-2531.20090089 復制

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26.	Kuzdza J, S?adek K, Wasowski D, et al. Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial. Med Sci Monit, 2003, 9(6): 154-159.

1. Simon GR, Turrisi A, American College of Chest Physicians. Management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 324S-39S.
2. Agra Y, Pelayo M, Sacristan M, et al. Chemotherapy versus bestsupportive care for extensive small cell lung cancer. Cochrane Database Syst Rev, 2003, (4).
3. Bozcuk H, Artac M, Ozdogan M, et al. Does maintenance/ consolidation chemotherapy have a role in the management of small cell lung cancer (SCLC)? A meta analysis of the published controlled trials. Cancer, 2005, 104(12): 2650-2657.
4. Prophylactic Cranial Irradiation Overview Collaborative Group. Cranial irradiation for preventing brain metastases of small cell lung cancer in patients in complete remission. Cochrane Database Syst Rev, 2000, (4).
5. Meert AP, Paesmans M, Berghmans T, et al. Prophylactic cranial irradiation in small cell lung cancer: a systematic review of the literature with meta-analysis. BMC Cancer, 2001, 1(5): 5.
6. Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med, 2007, 357(7): 664-672.
7. 王屏, 朱靜, 高仲陽. 艾迪注射液聯合化療治療中晚期肺癌的臨床療效觀察. 中國醫院藥學雜志, 2008, 28(1):51-53.
8. 趙新華, 蔣顯勇, 李慶, 等. 艾迪聯合化療治療晚期肺癌的臨床療效觀察. 中華腫瘤防治雜志, 2006, l3(2); l42-143.
9. 莫海鷹, 于新發, 王健. 艾迪注射液治療晚期肺癌療效觀察. 現代醫院, 2006, 6(9): 37-38.
10. European Lung Cancer Working Party (ELCWP). A systematic review of the role of etoposide and cisplatin in the chemotherapy of small cell lung cancer with methodology assessment and meta-analysis. Lung Cancer, 2000, 30(1): 23-36.
11. Noda K, Nishiwaki Y, Kawahara M, et al. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med, 2002, 346(2): 85-91.
12. Hanna N, Bunn PA Jr, Langer C, et al. Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol, 2006, 24(13): 2038-2043.
13. 潘登, 侯梅, 李慧, 等. 伊立替康聯合順鉑方案與足葉乙甙聯合順鉑方案治療小細胞肺癌的隨機對照臨床研究. 中國肺癌雜志, 2006, 9(5 ): 443-446.
14. R. B. Natale, P. N. Lara, K. Chansky, et al. S0124: A randomized phase III trial comparing irinotecan/cisplatin (IP) with etoposide/cisplatin (EP) in patients (pts) with previously untreated extensive stage small cell lung cancer (E-SCLC). J Clin Oncol, 2008 (May 20 suppl; abstr 7512).
15. Jiang L, Yang KH, Mi DH, et al. Safety of irinotecan/cisplatin versus etoposide/cisplatin for patients with extensive-stage small-cell lung cancer: a meta-analysis. Clin Lung Cancer, 2007 , 8(8): 497-501.
16. Pujol JL, Carestia L, Daures JP. Is there a case for cisplatin in the treatment of small-cell lung cancer: a meta-analysis of randomized trials of a cisplatin-containing regimen versus a regimen without this alkylating agent. Br J Cancer, 2000, 83(1): 8-15.
17. Brown DB, Bakal CW, Weintraub JL, et al. Expert Panel on Interventional Radiology. Hepatic malignancy. [online publication]. Reston (VA): American College of Radiology (ACR), 2007. 7 p.
18. Malaguarnera M, Trovato G, Restuccia S, et al. Treatment of nonresectable hepatocellular carcinoma: review of the literature and meta-analysis. Adv Ther, 1994, 11(6): 303-319.
19. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma:chemoembolization improves survival. Hepatology, 2003 , 37(2): 429-442.
20. Cammà C, Schepi s F , Orlando A, etal . Transarterial chemoembolization for unresectable hepatocellular carcinoma: metaanalysis of randomized controlled trials. Radiology, 2002, 224(1):47-54.
21. Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer. A national clinical guideline[EB/OL]. (2009-02-16) [2009-02-23]. http://www.guideline.gov/summary/summary.aspx? doc_id =6615 &nbr=004159&string=%22malignant+pleural+effusion%22+AND+therapy.
22. Mascaux C, Paesmans M, Berghmans T, et al. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004; (1).
23. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med, 1994, 120(1): 56-64.
24. Yoshida K, Sugiura T, Takifuji N, et al. Randomized phase II trial of three intrapleural therapy regimens for the management of malignant pleural effusion in previously untreated non-small cell lung cancer: JCOG 9515. Lung Cancer, 2007, 58(3): 362-368.
25. Sartori S, Tassinari D, Ceccotti P, et al. Prospective randomized trial of intrapleural bleomycin versus interferon alfa-2b via ultrasoundguided small-bore chest tube in the palliative treatment of malignant pleural effusions. J Clin Oncol, 2004 , 22(7):1228-1233.
26. Kuzdza J, S?adek K, Wasowski D, et al. Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial. Med Sci Monit, 2003, 9(6): 154-159.

《中國循證醫學雜志》

一例廣泛期小細胞肺癌的循證治療

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《中國循證醫學雜志》

一例廣泛期小細胞肺癌的循證治療

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