Small cell lung cancer grade 4. Intercellular cancer

small cell cancer lung is malignant neoplasm, which develops as a result of pathological changes in the cells of the mucous membrane respiratory tract. The disease is dangerous because it develops very quickly, already in the initial stages it can metastasize to the lymph nodes. The disease occurs more often in men than in women. At the same time, smokers are most susceptible to its occurrence.

As in any other cases, there are 4 stages of small-cell lung cancer pathology. Let's consider them in more detail:

1 stage	the tumor is small, localized in one segment of the organ, no metastasis
Stage 2 SCLC	the prognosis is quite comforting, although the size of the neoplasm is much larger, can reach 6 cm. Single metastases are observed. Their location is regional lymph nodes.
Stage 3 SCLC	the prognosis depends on the characteristics of the particular case. The tumor can exceed 6 cm in size. It spreads to neighboring segments. Metastases are more distant, but are within regional lymph nodes
Stage 4 SCLC	the prognosis is not as encouraging as in previous cases. The neoplasm goes beyond the organ. There is extensive metastasis

Of course, the success of treatment, as with any cancer, will depend on the timeliness of its detection.

Important! Statistics show that small cell makes up 25% of all existing varieties this disease. If metastasis is observed, in most cases it affects 90% thoracic lymph nodes. Slightly less will be the share of the liver, adrenal glands, bones and brain.

Clinical picture

The situation is aggravated by the fact that the symptoms of small cell lung cancer at the initial stage are practically not noticeable. They can often be confused with common colds, because a person will have a cough, hoarseness, shortness of breath. But, when the disease becomes more serious, the clinical picture becomes brighter. A person will notice signs such as:

• a worsening cough that does not go away after taking conventional antitussive drugs;
• pain in the chest area that occurs systematically, increasing its intensity over time;
• hoarseness of voice;
• impurities of blood in sputum;
• shortness of breath even in the absence of physical exertion;
• loss of appetite, and accordingly, weight;
• chronic fatigue, drowsiness;
• difficulty in swallowing.

These symptoms should prompt immediate medical attention. Only timely diagnosis and effective therapy will help improve the prognosis for SCLC.

Diagnosis and features of treatment

Important! Most often, SCLC is diagnosed in people aged 40-60 years. At the same time, the proportion of men is 93%, and women suffer from this form of oncology only in 7% of total cases.

High-precision diagnostics performed by experienced specialists is the key to successful getting rid of the disease. It will allow you to confirm the presence of oncology, as well as determine exactly what kind of it you have to deal with. It is possible that we are talking about non-small cell lung cancer, which is considered a less aggressive type of disease, allows you to make more comforting predictions.

The main diagnostic methods should be:

1. laboratory blood tests;
2. sputum analysis;
3. radiography chest;
4. body CT;

Important! A lung biopsy is mandatory, followed by examination of the material. It allows you to more accurately determine the features of the neoplasm and its nature. A biopsy may be performed during bronchoscopy.

This is a standard list of studies that a patient must undergo. It can be supplemented by others diagnostic procedures if there is such a need.

If we talk about the treatment of small cell lung cancer, then its main method remains surgical intervention, as in other types of oncology. It is carried out in two ways - open and minimally invasive. The latter is more preferable, because it is considered less traumatic, has fewer contraindications, and is characterized by high accuracy. Such operations are performed through small incisions on the patient's body, controlled by special video cameras that display the image on the monitor.

Given the fact that the type of oncology in question is progressing very quickly, often detected already at the stage of metastasis, doctors will use chemotherapy or radiation therapy as additional methods treatment of SCLC. At the same time, irradiation or therapy with anticancer drugs can be carried out before surgery, with the goal of stopping tumor growth, destroying cancer cells, and are often performed after surgery - here they are needed to consolidate the result and prevent relapse.

Additional therapies can be used in combination. This way you can achieve more significant result. Sometimes doctors resort to polychemotherapy, combining several drugs. Everything will depend on the stage of the disease, the characteristics of the state of health of a particular patient. Radiation therapy for SCLC can be internal or external – suitable method determined by the scale of the neoplasm, as well as the prevalence of metastases.

As for the question - how many people live with SCLC, it is difficult to give an unambiguous answer here. Everything will depend on the stage of the disease. But, given the fact that pathology is often detected already in the presence of metastasis, the main factors determining life expectancy will be: the number of metastases and their location; professionalism of attending physicians; the accuracy of the equipment used.

In any case, even with the last stage of the disease, there is a chance to extend the life of the patient by 6-12 months, significantly alleviating the symptoms.

(Moscow, 2003)

N. I. Perevodchikova, M. B. Bychkov.

Small cell lung cancer (SCLC) is a peculiar form of lung cancer, significantly different in its biological characteristics from other forms, united by the term non-small cell lung cancer (NSCLC).

There is strong evidence that SCLC is associated with smoking. This confirms the changing frequency of this form of cancer.

Analysis of SEER data for 20 years (1978-1998) showed that, despite the annual increase in the number of patients with lung cancer, the percentage of patients with SCLC decreased from 17.4% in 1981 to 13.8% in 1998, which, according to appears to be related to the intense anti-smoking campaign in the US. Noteworthy is the relative, compared with 1978, reduction in the risk of death from SCLC, first recorded in 1989. In subsequent years, this trend continued, and in 1997 the risk of death from SCLC was 0.92 (95% Cl 0.89 - 0.95,<0,0001) по отношению к риску смерти в 1978 г., принятому за единицу. Эти достаточно скромные, но стойкие результаты отражают реальное улучшение результатов лечения больных МРЛ -крайне злокачественной, быстро растущей опухоли, без лечения приводящей к смерти в течение 2-4 месяцев с момента установления диагноза.

The biological features of SCLC determine the rapid growth and early generalization of the tumor, which at the same time has a high sensitivity to cytostatics compared to NSCLC and radiotherapy.

As a result of the intensive development of methods for the treatment of SCLC, the survival of patients receiving modern therapy has increased by 4-5 times compared to untreated patients, about 10% of the entire population of patients have no signs of the disease within 2 years after the end of treatment, 5-10% live more 5 years without signs of recurrence of the disease, i.e., they can be considered cured, although they are not guaranteed against the possibility of resumption of tumor growth (or the occurrence of NSCLC).

The diagnosis of SCLC is finally established by morphological examination and is built clinically on the basis of radiographic data, in which the central location of the tumor is most often detected, often with atelectasis and pneumonia and early involvement of the lymph nodes of the root and mediastinum. Often, patients develop mediastinal syndrome - signs of compression of the superior vena cava, as well as metastatic lesions of the supraclavicular and less often other peripheral lymph nodes and symptoms associated with the generalization of the process (metastatic lesions of the liver, adrenal glands, bones, bone marrow, central nervous system).

About two-thirds of patients suffering from SCLC, already at the first visit, have signs of metastasis, 10% have metastases in the brain.

Neuroendocrine paraneoplastic syndromes are more common in SCLC than in other forms of lung cancer. Recent studies have made it possible to clarify a number of neuroendocrine characteristics of SCLC and identify markers that can be used to monitor the course of the process, but not for early diagnosis. cancer embryonic antigen (CEA).

The importance of "antioncogenes" (tumor suppressor genes) in the development of SCLC has been shown, and genetic factors that play a role in its occurrence have been identified.

A number of monoclonal antibodies to surface antigens of small cell lung cancer cells have been isolated, but so far the possibilities of their practical application have been limited mainly to the identification of SCLC micrometastases in the bone marrow.

Staging and prognostic factors.

When diagnosing SCLC, the assessment of the prevalence of the process, which determines the choice of therapeutic tactics, is of particular importance. After morphological confirmation of the diagnosis (bronchoscopy with biopsy, transthoracic puncture, biopsy of metastatic nodes), CT of the chest and abdomen is performed, as well as CT or MRI of the brain with contrast and bone scanning.

AT recent times there have been reports that positron emission tomography (PET) can further refine the stage of the process.

With the development of new diagnostic techniques, bone marrow puncture has largely lost its diagnostic value, which remains relevant only in the case of clinical signs of bone marrow involvement in the process.

In SCLC, as in other forms of lung cancer, staging is used according to the international TNM system, however, most patients with SCLC already have III-IV stages of the disease at the time of diagnosis, which is why the Veterans Administration Lung Cancer Study Group classification has not lost its significance so far, according to which distinguish between patients with localized SCLC (Limited Disease) and widespread SCLC (Extensive Disease).

In localized SCLC, the tumor lesion is limited to one hemithorax with involvement in the process of regional and contralateral lymph nodes of the mediastinal root and ipsilateral supraclavicular lymph nodes, when irradiation using a single field is technically possible.

Widespread SCLC is a process that goes beyond the localized. Ipsilateral lung metastases and the presence of tumor pleurisy indicates widespread SCRL.

The stage of the process that determines therapeutic options is the main prognostic factor in SCLC.

Surgical treatment is possible only in the early stages of SCLC - with a primary T1-2 tumor without regional metastases or with lesions of the bronchopulmonary lymph nodes (N1-2).

However, one surgical treatment or a combination of surgery with radiation does not provide satisfactory long-term results. A statistically significant increase in life expectancy is achieved with the use of postoperative adjuvant combined chemotherapy (4 courses).

According to the summary data of modern literature, the five-year survival rate of operable SCLC patients who underwent combined chemotherapy or combined chemoradiotherapy in the postoperative period is about 39%.

Randomized trial shows advantage of surgery over radiotherapy as a first step complex treatment technically operable patients with SCLC; five-year survival rate at stages I-II in the case of surgery with postoperative chemotherapy was 32.8%.

The feasibility of using neoadjuvant chemotherapy for localized SCLC, when patients underwent surgery after achieving the effect of induction therapy, continues to be studied. Despite the attractiveness of the idea, randomized trials have not yet made it possible to draw an unambiguous conclusion about the benefits of this approach.

Even in the early stages of SCLC, chemotherapy is an essential component of complex treatment.

In the later stages of the disease, the basis of therapeutic tactics is the use of combined chemotherapy, and in the case of localized SCLC, the expediency of combining chemotherapy with radiation therapy has been proven, and in advanced SCLC, the use of radiation therapy is possible only if indicated.

Patients with localized SCLC have a significantly better prognosis compared with patients with advanced SCLC.

The median survival of patients with localized SCLC when using combinations of chemotherapy and radiation therapy in the optimal mode is 16-24 months with a 40-50% two-year survival rate and a five-year survival rate of 5-10%. In a group of patients with localized SCLC who started treatment in good general condition, a five-year survival rate of up to 25% is possible. In patients with advanced SCLC, median survival may be 8–12 months, but long-term disease-free survival is extremely rare.

A favorable prognostic sign for SCLC, in addition to a localized process, is a good general condition (Perfomance Status) and, according to some reports, a female gender.

Other prognostic signs - age, histological subtype of the tumor and its genetic characteristics, the level of LDH in the blood serum are ambiguously regarded by various authors.

The response to induction therapy also makes it possible to predict the results of treatment: only the achievement of a complete clinical effect, i.e., complete regression of the tumor, allows us to count on a long relapse-free period until a cure. There is evidence that patients with SCLC who continue to smoke during treatment have a worse survival rate compared to patients who quit smoking.

In the event of a recurrence of the disease, even after successful treatment of SCLC, it is usually not possible to achieve a cure.

Chemotherapy for SCLC.

Chemotherapy is the mainstay of treatment for patients with SCLC.

Classical cytostatics of the 70-80s, such as cyclophosphamide, ifosfamide, nitroso derivatives of CCNU and ACNU, methotrexate, doxorubicin, epirubicin, etoposide, vincristine, cisplatin and carboplatin, have an antitumor activity in SCLC of the order of 20-50%. However, monochemotherapy is usually not effective enough, the resulting remissions are unstable, and the survival of patients who received chemotherapy with the drugs listed above does not exceed 3-5 months.

Accordingly, monochemotherapy has retained its significance only for a limited contingent of patients with SCLC, who, according to their general condition, are not subject to more intensive treatment.

Based on the combination of the most active drugs, combination chemotherapy regimens have been developed, which are widely used in SCLC.

Over the past decade, the combination of EP or EC (etoposide + cisplatin or carboplatin) has become the standard for the treatment of patients with SCLC, replacing the previously popular combinations CAV (cyclophosphamide + doxorubicin + vincristine), ACE (doxorubicin + cyclophosphamide + etoposide), CAM (cyclophosphamide + doxorubicin + methotrexate) and other combinations.

It has been proven that combinations of EP (etoposide + cisplatin) and EC (etoposide + carboplatin) have antitumor activity in advanced SCLC of the order of 61-78% ( full effect in 10-32% of patients). Median survival is 7.3 to 11.1 months.

A randomized trial comparing the combination of cyclophosphamide, doxorubicin, and vincristine (CAV), etoposide with cisplatin (EP), and alternating CAV and EP showed similar overall efficacy of all three regimens (OE -61%, 51%, 60%) with no significant difference in time to progression (4.3, 4 and 5.2 months) and survival (median 8.6, 8.3 and 8.1 months), respectively. The inhibition of myelopoiesis was less pronounced with EP.

Because cisplatin and carboplatin are equally effective in SCLC with better tolerability of carboplatin, combinations of etoposide with carboplatin (EC) and etoposide with cisplatin (EP) are used as interchangeable therapeutic regimens for SCLC.

The main reason for the popularity of the EP combination is that, having an equal antitumor activity with the CAV combination, it inhibits myelopoiesis to a lesser extent compared to other combinations, less limiting the possibilities of using radiation therapy - according to modern concepts, an obligatory component of localized SCLC therapy.

Most of the new regimens of modern chemotherapy are based either on the addition of a new drug to the EP (or EC) combination, or on the basis of replacing etoposide with a new drug. A similar approach is used for well-known drugs.

Thus, the pronounced antitumor activity of ifosfamide in SCLC served as the basis for the development of the ICE combination (ifosfamide + carboplatin + etoposide). This combination turned out to be highly effective, however, despite the pronounced antitumor effect, severe hematological complications served as obstacles to its widespread use in clinical practice.

at RONC im. N. N. Blokhin of the Russian Academy of Medical Sciences developed the combination AVP (ACNU + etoposide + cisplatin), which has a pronounced antitumor activity in SCLC and, most importantly, is effective in brain and visceral metastases.

AVP combination (ACNU 3-2 mg/m 2 on day 1, etoposide 100 mg/m 2 on days 4, 5, 6, cisplatin 40 mg/m 2 on days 2 and 8 cycling every 6 weeks) has been used to treat 68 patients (15 with localized and 53 with advanced SCLC). The effectiveness of the combination was 64.7% with complete tumor regressions in 11.8% of patients and a median survival of 10.6 months. With SCLC metastases in the brain (29 evaluated patients), complete regression as a result of the use of the AVP combination was achieved in 15 (52% of patients), partial regression in three (10.3%) with a median time to progression of 5.5 months. Side effects of the AVP combination were myelosuppressive (leukopenia III-IV stage -54.5%, thrombocytopenia III-IV stage -74%) and were reversible.

New anticancer drugs.

In the nineties of the XX century, a number of new cytostatics with antitumor activity in SCLC came into practice. These include the taxanes (Taxol or paclitaxel, Taxotere or docetaxel), gemcitabine (Gemzar), the topoisomerase I inhibitors topotecan (Hycamtin) and irinotecan (Campto), and the vinca alkaloid Navelbine (vinorelbine). In Japan, a new anthracycline, Amrubicin, is being studied for SCLC.

In connection with the proven possibility of curing patients with localized SCLC using modern chemoradiotherapy, for ethical reasons, clinical trials of new anticancer drugs are conducted in patients with advanced SCLC, or in patients with localized SCLC in case of relapse of the disease.

Table 1
New drugs for advanced SCLC (I line of therapy) / according to Ettinger, 2001.

A drug		Number of b-ths (estimated)	Overall effect (%)	Median survival (months)
Taxotere
Topotecan
Irinotecan
Irinotecan
Vinorelbine
Gemcitabine
Amrubicin

Summary data on the antitumor activity of new anticancer drugs in SCLC are presented by Ettinger in a 2001 review. .

Information on the results of the use of new anticancer drugs in previously untreated patients with advanced SCLC (I-line chemotherapy) is included. Based on these new drugs, combinations have been developed that pass through phases II-III clinical study.

Taxol (paclitaxel).

In the ECOG study, 36 previously untreated patients with advanced SCLC received Taxol at a dose of 250 mg/m 2 as a daily intravenous infusion once every 3 weeks. 34% had a partial effect, and the calculated median survival was 9.9 months. In 56% of patients, treatment was complicated by stage IV leukopenia, 1 patient died of sepsis.

In the NCTG study, 43 patients with SCLC received similar therapy under the protection of G-CSF. 37 patients were evaluated. The overall effectiveness of chemotherapy was 68%. Full effects were not recorded. Median survival was 6.6 months. Grade IV neutropenia complicated 19% of all chemotherapy courses.

With resistance to standard chemotherapy, Taxol at a dose of 175 mg/m 2 was effective in 29%, the median time to progression was 3.3 months. .

The pronounced antitumor activity of Taxol in SCLC served as the basis for the development of combination chemotherapy regimens with the inclusion of this drug.

The possibility of combined use of combinations of Taxol and doxorubicin, Taxol and platinum derivatives, Taxol with topotecan, gemcitabine and other drugs in SCLC has been studied and continues to be studied.

The feasibility of using Taxol in combination with platinum derivatives and etoposide is being most actively investigated.

In table. 2 presents his results. All patients with localized SCLC received additional radiation therapy of the primary focus and mediastinum simultaneously with the third and fourth cycles of chemotherapy. The effectiveness of the studied combinations was noted in case of severe toxicity of the combination of Taxol, carboplatin and topotecan.

table 2
The results of applying three therapeutic regimens including Taxol for SCLC. (Hainsworth, 2001) (30)

Therapeutic regimen	Number of patients II r/l		Overall Efficiency	Median survival (month)	Survival		Hematological complications
							Leukopenia III-IV Art.	Platelet singing	Death from sepsis
Taxol 135 mg/m2 Carboplatin AUC-5
Taxol 200 mg/m2 Carboplatin AUC-6 Etoposide 50/100mg x 10 days every 3 weeks
Taxol 100 mg/m2 Carboplatin AUC-5 Topotecan 0.75* mg/m 2 Zdn. every 3 weeks

p-distributed SCLC
l-localized SCRL

The multicenter, randomized study CALGB9732 compared the efficacy and tolerability of combinations of α-etoposide 80 mg/m 2 days 1-3 and cisplatin 80 mg/m 2 1 day cycling every 3 weeks (Arm A) and the same combination supplemented with Taxol 175 mg/m 2 - 1 day and G-CSF 5 mcg / kg 8-18 days of each cycle (gr. B).

The experience of treating 587 patients with advanced SCLC who had not previously received chemotherapy showed that the survival of patients in the compared groups did not differ significantly:

In group A, the median survival was 9.84 months. (95% CI 8, 69 - 11.2) in group B 10, 33 months. (95% CI 9.64-11.1); 35.7% (95% CI 29.2-43.7) of patients in group A and 36.2% (95% CI 30-44.3) of patients in group B lived for more than a year. (drug-induced death) was higher in group B, which led the authors to conclude that the addition of Taxol to combinations of etoposide and cisplatin in the first line of chemotherapy for advanced SCLC increased toxicity without significantly improving treatment outcomes (Table 3).

Table H
Results of a Randomized Trial Evaluating the Efficacy of Adding Taxol to Etoposide/Cisplatin in 1-Line Chemotherapy for Advanced SCLC (Study CALGB9732)

	Number of patients	Survival		Toxicity > III Art.
		Median (months)		neutropenia	thrombocytopenia			neuro-toxicity	Lek. death
Etoposide 80 mg / m 2 1-3 days, cisplatin 80 mg / m 2 - 1 day. every 3 weeks x6		9,84 (8,69- 11,2)	35,7% (29,2-43,7)
Etoposide 80 mg / m 2 1-3 days, cisplatin 80 mg / m 2 - 1 day, Taxol 175 mg / m 2 1 day, G CSF 5 mcg / kg 4-18 days, every 3 weeks x6		10,33 (9,64-11,1)

From the analysis of the pooled data from the ongoing phase II-III clinical trials, it is clear that the inclusion of Taxol may increase the effectiveness of combination chemotherapy,

increasing, however, the toxicity of some combinations. Accordingly, the advisability of including Taxol in combination chemotherapy regimens for SCLC continues to be intensively studied.

Taxotere (doietaxel).

Taxotere (Docetaxel) entered clinical practice later than Taxol and, accordingly, later began to be studied in SCLC.

In a phase II clinical study in 47 previously untreated patients with advanced SCLC, Taxotere was shown to be 26% effective with a median survival of 9 months. Grade IV neutropenia complicated the treatment of 5% of patients. Febrile neutropenia was registered, one patient died of pneumonia.

The combination of Taxotere and cisplatin was studied as the first line of chemotherapy in patients with advanced SCLC in the Chemotherapy Department of the Russian Cancer Research Center. N. N. Blokhin RAMS.

Taxotere at a dose of 75 mg/m 2 and cisplatin 75 mg/m 2 were administered intravenously once every 3 weeks. Treatment was continued until progression or intolerable toxicity. In case of full effect, 2 cycles of consolidating therapy were additionally carried out.

Of the 22 patients to be evaluated, the full effect was registered in 2 patients (9%) and the partial effect in 11 (50%). The overall effectiveness was 59% (95% CI 48, 3-69.7%).

The median duration of response was 5.5 months, the median survival was 10.25 months. (95% Cl 9.2-10.3). 41% of patients survived 1 year (95% Cl 30.3-51.7%).

The main manifestation of toxicity was neutropenia (18.4% - stage III and 3.4% - stage IV), febrile neutropenia occurred in 3.4%, and there were no drug-induced deaths. Non-hematological toxicity was moderate and reversible.

Topoisomerase I inhibitors.

Among the drugs from the group of topomerase I inhibitors, topotecan and irinotecan are used for SCLC.

Topotecan (Hycamtin).

In the ECOG study, topotecan (Hycamtin) at a dose of 2 mg/m 2 was administered daily for 5 consecutive days every 3 weeks. In 19 out of 48 patients, a partial effect was achieved (effectiveness 39%), the median survival of patients was 10.0 months, 39% of patients survived one year. 92% of patients who did not receive CSF had grade III-IV neutropenia, grade III-IV thrombocytopenia. registered in 38% of patients. Three patients died from complications.

As a second-line chemotherapy, topotecan was effective in 24% of previously responding patients and in 5% of refractory patients.

Accordingly, a comparative study of topotecan and the combination of CAV was organized in 211 patients with SCLC who had previously responded to the first line of chemotherapy ("sensitive" relapse). In this randomized trial, topotecan 1.5 mg/m 2 was administered intravenously daily for five consecutive days every 3 weeks.

The results of topotecan did not differ significantly from the results of chemotherapy with the CAV combination. The overall effectiveness of topotecan was 24.3%, CAV - 18.3%, time to progression 13.3 and 12.3 weeks, median survival 25 and 24.7 weeks, respectively.

Stage IV neutropenia complicated topotecan therapy in 70.2% of patients, CAV therapy in 71% (febrile neutropenia in 28% and 26%, respectively). The advantage of topotecan was a significantly more pronounced symptomatic effect, which is why the US FDA recommended this drug as a second-line chemotherapy for SCLC.

Irinotecan (Campto, CPT-II).

Irinotecan (Campto, CPT-II) proved to have a fairly pronounced antitumor activity in SCLC.

In a small group of previously untreated patients with advanced SCLC, it was effective at 100 mg/m 2 weekly in 47-50%, although the median survival of these patients was only 6.8 months. .

In several studies, irinotecan has been used in patients with relapses after standard chemotherapy, with efficacy ranging from 16% to 47%.

The combination of irinotecan with cisplatin (cisplatin 60 mg/m 2 on day 1, irinotecan 60 mg/m 2 on days 1, 8, 15 cycling every 4 weeks, for a total of 4 cycles) was compared in a randomized trial with the standard combination of EP (cisplatin 80 mg / m 2 -1 day, etoposide 100 mg / m 2 days 1-3) in patients with previously untreated advanced SCLC. The combination with irinotecan (CP) was superior to the EP combination (overall efficacy 84% versus 68%, median survival 12.8 months versus 9.4 months, two-year survival 19% and 5%, respectively).

The toxicity of the compared combinations was comparable: neutropenia more often complicated ER (92%) compared to the CP regimen (65%), diarrhea III-IV stage. occurred in 16% of patients treated with SR.

Also noteworthy is the report on the effectiveness of the combination of irinotecan with etoposide in patients with recurrent SCLC (overall efficacy 71%, time to progression 5 months).

Gemcitabine.

Gemcitabine (Gemzar) at a dose of 1000 mg/m 2 escalated to 1250 mg/m 2 weekly for 3x weeks, cycling every 4 weeks was used in 29 patients with advanced SCLC as 1st line chemotherapy. Overall efficacy was 27% with a median survival of 10 months. Gemcitabine was well tolerated.

The combination of cisplatin and gemcitabine used in 82 patients with advanced SCLC was effective in 56% of patients with a median survival of 9 months. .

Good tolerability and results comparable to standard regimens of gemcitabine in combination with carboplatin in SCLC served as the basis for the organization of a multicenter randomized study comparing the results of the combination of gemcitabine with carboplatin (GC) and the combination of EP (etoposide with cisplatin) in patients with SCLC with a poor prognosis. Patients with advanced SCLC and patients with localized SCLC who have adverse factors prognosis - only 241 patients. Combination GP (gemcitabine 1200 mg/m 2 on days 1 and 8 + carboplatin AUC 5 on day 1 every 3 weeks, up to 6 cycles) was compared with combination EP (cisplatin 60 mg/m 2 on days 1 + etoposide 100 mg/m 2 per os 2 times a day 2 and 3 days every 3 weeks). Patients with localized SCLC who responded to chemotherapy received additional radiation therapy and prophylactic brain irradiation.

The efficacy of the GC combination was 58%, the EP combination was 63%, median survival was 8.1 and 8.2 months, respectively, with satisfactory chemotherapy tolerance.

Another randomized trial, which included 122 patients with SCLC, compared the results of using 2 combinations containing gemcitabine. The PEG combination included cisplatin 70 mg/m 2 on day 2, etoposide 50 mg/m 2 on days 1-3, gemcitabine 1000 mg/m 2 on days 1 and 8. The cycle was repeated every 3 weeks. The PG combination included cisplatin 70 mg/m 2 on day 2, gemcitabine 1200 mg/m 2 on days 1 and 8 every 3 weeks. The combination of PEG was effective in 69% of patients (complete effect in 24%, partial in 45%), the combination of PG in 70% (complete effect in 4% and partial in 66%).

The study of the possibility of improving the results of SCLC treatment by the use of new cytostatics is ongoing.

It is still difficult to unambiguously determine which of them will change the current possibilities of treating this tumor, but the fact that the antitumor activity of taxanes, topoisomerase I inhibitors and gemcitabine has been proven allows us to hope for further improvement of modern therapeutic regimens for SCLC.

Molecularly targeted "targeted" therapy for SCLC.

Fundamentally new group anticancer drugs are molecularly targeted, the so-called targeted (target - target, goal), drugs with true selectivity of action. The results of molecular biology studies convincingly prove that the 2 main subtypes of lung cancer (SCLC and NSCLC) have both common and significantly different genetic characteristics. Due to the fact that SCLC cells, unlike NSCLC cells, do not express epidermal growth factor receptors (EGFR) and cyclooxygenase 2 (COX2), there is no reason to expect the possible effectiveness of such drugs as Iressa (ZD1839), Tarceva (OS1774) or Celecoxib, which are being intensively studied in NSCLC.

At the same time, up to 70% of SCLC cells express the Kit proto-oncogene encoding the CD117 tyrosine kinase receptor.

The tyrosine kinase inhibitor Kit Glivec (ST1571) is in clinical trials for SCLC.

The first results of the use of Glivec at a dose of 600 mg/m 2 orally daily as the only drug in previously untreated patients with advanced SCLC showed its good tolerability and the need to select patients depending on the presence of a molecular target (CD117) in the patient's tumor cells.

Tirapazamine, a hypoxic cytotoxin, and Exizulind, which affects apoptosis, are also being studied from this series of drugs. The expediency of using these drugs in combination with standard therapeutic regimens is being evaluated in order to improve the survival of patients.

Therapeutic tactics for SCLC

Therapeutic tactics in SCLC is determined primarily by the prevalence of the process and, accordingly, we specifically dwell on the issue of treating patients with localized, widespread and recurrent SCLC.

Some issues are preliminarily considered general: intensification of doses of anticancer drugs, the feasibility of maintenance therapy, treatment of elderly patients and patients in severe general condition.

Dose intensification in SCLC chemotherapy.

The issue of the advisability of intensifying chemotherapy doses in SCLC has been actively studied. In the 1980s, there was an idea that the effect was directly dependent on the intensity of chemotherapy. However, a number of randomized trials did not reveal a clear correlation between the survival of patients with SCLC and the intensity of chemotherapy, which was confirmed by a meta-analysis of 60 studies on this issue.

Arrigada et al. used a moderate initial intensification of the therapeutic regimen, comparing in a randomized study cyclophosphamide at a course dose of 1200 mg / m 2 + cisplatin 100 mg / m 2 and cyclophosphamide 900 mg / m 2 + cisplatin 80 mg / m 2 as 1 cycle of treatment (further therapeutic modes were the same). Among 55 patients who received higher doses of cytostatics, two-year survival was 43% compared with 26% for 50 patients who received lower doses. Apparently, it was the moderate intensification of induction therapy that turned out to be a favorable moment, which made it possible to obtain a pronounced effect without a significant increase in toxicity.

An attempt to increase the effectiveness of chemotherapy by intensifying therapeutic regimens using bone marrow autotransplantation, peripheral blood stem cells and the use of colony-stimulating factors (GM-CSF and G-CSF) showed that despite the fact that such approaches are fundamentally possible and it is possible to increase the percentage of remissions, the survival rate of patients cannot be significantly increased.

In the Chemotherapy Department of the Oncology Center of the Russian Academy of Medical Sciences, 19 patients with localized SCLC received therapy according to the CAM scheme in the form of 3 cycles with an interval of 14 days instead of 21 days. GM-CSF (leukomax) at a dose of 5 µg/kg was administered subcutaneously daily for 2-11 days of each cycle. When compared with the historical control group (25 patients with localized SCLC who received SAM without GM-CSF), it turned out that despite the intensification of the regimen by 33% (the dose of cyclophosphamide was increased from 500 mg/m 2 /week to 750 mg/m 2 /week , Adriamycin from 20 mg/m 2 /week to 30 mg/m 2 /week and Methotrexate from 10 mg/m 2 /week to 15 mg/m 2 /week) the results of treatment in both groups are identical.

A randomized trial showed that the use of GCSF (lenograstim) at a dose of 5 μg/kg per day in the intervals between VICE cycles (vincristine + ifosfamide + carboplatin + etoposide) can increase the intensity of chemotherapy and increase two-year survival, but at the same time, the toxicity of the intensified regimen increases significantly (out of 34 patients, 6 died from toxicosis).

Thus, despite ongoing research into early intensification of therapeutic regimens, there is no conclusive evidence for the benefit of this approach. The same applies to the so-called late intensification of therapy, when patients who have achieved remission after conventional induction chemotherapy are given high doses of cytostatics under the protection of bone marrow or stem cell autotransplantation.

In a study by Elias et al, patients with localized SCLC who achieved complete or significant partial remission after standard chemotherapy underwent high-dose consolidation chemotherapy with autologous bone marrow transplantation and radiation. After such intensive care Fifteen of 19 patients had complete tumor regression, and the two-year survival rate reached 53%. The late intensification method is the subject clinical research and has not yet gone beyond the clinical experiment.

supportive therapy.

The notion that long-term maintenance chemotherapy can improve long-term outcomes in patients with SCLC has been refuted by a number of randomized trials. There was no significant difference in the survival of patients who received long-term maintenance therapy and those who did not receive it. Some studies have shown an increase in time to progression, which, however, was achieved at the expense of a decrease in the quality of life of patients.

Modern SCLC therapy does not provide for the use of maintenance therapy, both with cytostatics and with the help of cytokines and immunomodulators.

Treatment of elderly patients with SCLC.

The possibility of treating elderly patients with SCLC is often questioned. However, the age of even more than 75 years cannot serve as a basis for refusing to treat patients with SCLC. In the case of a severe general condition and the inability to use chemoradiotherapy, the treatment of such patients can begin with the use of oral etoposide or cyclophosphamide, followed, if the condition improves, by switching to standard chemotherapy EC (etoposide + carboplatin) or CAV (cyclophosphamide + doxorubicin + vincristine).

Modern possibilities of therapy of patients with localized SCLC.

Efficiency modern therapy with localized SCLC, it ranges from 65 to 90%, with complete tumor regression in 45-75% of patients and a median survival of 18-24 months. Patients who started treatment in good general condition (PS 0-1) and responded to induction therapy have a chance of a five-year relapse-free survival.

The combined use of combined chemotherapy and radiation therapy in localized forms of small cell lung cancer has received universal recognition, and the advantage of this approach has been proven in a number of randomized trials.

A meta-analysis of data from 13 randomized trials evaluating the role of chest radiation plus combination chemotherapy in localized SCLC (2140 patients) showed that the risk of death in patients who received chemotherapy plus radiation was 0.86 (95% confidence interval 0.78 - 0.94) in relation to patients who received only chemotherapy, which corresponds to a 14% reduction in the risk of death. Three-year overall survival with the use of radiation therapy was better by 5.4 + 1.4%, which allowed us to confirm the conclusion that the inclusion of radiation significantly improves the results of treatment of patients with localized SCLC.

N. Murray et al. studied the question of the optimal timing of the inclusion of radiation therapy in patients with localized SCLC receiving alternating courses of combined CAV and EP chemotherapy. A total of 308 patients were randomized per group to receive 40 Gy in 15 fractions starting from the third week, concurrently with the first EP cycle, and to receive the same radiation dose during the last EP cycle, i.e. from week 15 of treatment. It turned out that although the percentage of complete remissions did not differ significantly, recurrence-free survival was significantly higher in the group receiving radiation therapy at an earlier time.

The optimal sequence of chemotherapy and radiation, as well as specific therapeutic regimens, are the subject of further research. In particular, a number of leading American and Japanese experts prefer to use a combination of cisplatin with etoposide, starting radiation simultaneously with the first or second cycle of chemotherapy, while at the ONC RAMS, radiation therapy at a total dose of 45-55 Gy is more often performed sequentially.

A study of the long-term results of liver treatment in 595 patients with inoperable SCLC who completed therapy at the ONC more than 10 years ago showed that the combination of combined chemotherapy with irradiation of the primary tumor, mediastinum, and supraclavicular lymph nodes increased the number of clinical complete remissions in patients with a localized process up to 64%. The median survival of these patients reached 16.8 months (in patients with complete tumor regression, the median survival is 21 months). 9% are alive without signs of disease for more than 5 years, that is, they can be considered cured.

The question of the optimal duration of chemotherapy in localized SCLC is not entirely clear, but there is no evidence of improved survival in patients treated for more than 6 months.

The following combination chemotherapy regimens have been tested and widely used:
EP - etoposide + cisplatin
EU - etoposide + carboplatin
CAV - cyclophosphamide + doxorubicin + vincristine

As mentioned above, the effectiveness of the EP and CAV regimens in SCLC is almost the same, however, the combination of etoposide with cisplatin, which inhibits hematopoiesis less, is more easily combined with radiation therapy.

There is no evidence of benefit from alternating courses of CP and CAV.

The feasibility of including taxanes, gemcitabine, topoisomerase I inhibitors, and targeted drugs in combination chemotherapy regimens continues to be studied.

Patients with localized SCLC who achieve complete clinical remission have a 60% actuarial risk of developing brain metastases within 2-3 years from the start of treatment. The risk of developing brain metastases can be reduced by more than 50% when using prophylactic brain irradiation (PMB) at a total dose of 24 Gy. A meta-analysis of 7 randomized trials evaluating POM in patients in complete remission showed a reduction in the risk of brain damage, improvement in disease-free survival and overall survival of patients with SCLC. Three-year survival increased from 15% to 21% with prophylactic brain irradiation.

Principles of therapy for patients with advanced SCLC.

In patients with advanced SCLC, in whom combination chemotherapy is the main method of treatment, and irradiation is performed only for special indications, the overall effectiveness of chemotherapy is 70%, but complete regression is achieved only in 20% of patients. At the same time, the survival rate of patients upon achieving complete tumor regression is significantly higher than in patients treated with a partial effect, and approaches the survival rate of patients with localized SCLC.

With SCLC metastases in the bone marrow, metastatic pleurisy, metastases in distant lymph nodes, combined chemotherapy is the method of choice. In case of metastatic lesions of the mediastinal lymph nodes with the syndrome of compression of the superior vena cava, it is advisable to use combined treatment (chemotherapy in combination with radiation therapy). With metastatic lesions of the bones, brain, adrenal glands, radiation therapy is the method of choice. With brain metastases, radiation therapy in SOD 30 Gy makes it possible to obtain a clinical effect in 70% of patients, and in half of them complete regression of the tumor is recorded according to CT data. Recently, data have appeared on the possibility of using systemic chemotherapy for SCLC metastases in the brain.

The experience of RONTS them. N. N. Blokhin of the Russian Academy of Medical Sciences for the treatment of 86 patients with CNS lesions showed that the use of combined chemotherapy can lead to complete regression of SCLC brain metastases in 28.2% and partial regression in 23%, and in combination with brain irradiation, the effect is achieved in 77.8% of patients with complete tumor regression in 48.2%. The problems of complex treatment of SCLC metastases in the brain are discussed in the article by Z. P. Mikhina et al. in this book.

Therapeutic tactics in recurrent SCLC.

Despite the high sensitivity to chemotherapy and radiotherapy, SCLC mostly recurs, and in such cases, the choice of therapeutic tactics (second-line chemotherapy) depends on the response to the first line of therapy, the time interval elapsed after its completion, and the nature of the spread of the tumor (localization of metastases) .

It is customary to distinguish between patients with sensitive relapse of SCLC who had a full or partial response to first-line chemotherapy and progression of the tumor process no earlier than 3 months after the end of induction therapy, and patients with refractory relapse who progressed during induction therapy or less than 3 months after its end. .

The prognosis for patients with recurrent SCLC is extremely unfavorable and there is no reason to expect a cure. It is especially unfavorable for patients with refractory relapse of SCLC, when the median survival after the detection of a relapse does not exceed 3-4 months.

With sensitive relapse, an attempt may be made to re-apply a therapeutic regimen that was effective in induction therapy.

For patients with refractory relapse, it is advisable to use antitumor drugs or their combinations that were not used during induction therapy.

The response to chemotherapy in relapsed SCLC depends on whether the relapse is sensitive or refractory.

Topotecan was effective in 24% of patients with sensitive and 5% of patients with resistant relapse.

The efficacy of irinotecan in sensitive relapsed SCLC was 35.3% (time to progression 3.4 months, median survival 5.9 months), while in refractory relapse the efficacy of irinotecan was 3.7% (time to progression 1.3 months). , median survival 2.8 months).

Taxol at a dose of 175 mg/m 2 with refractory relapse of SCLC was effective in 29% of patients with a median time to progression of 2 months. and a median survival of 3.3 months. .

A study of Taxotere in relapse) SCLC (without division into sensitive and refractory) showed its antitumor activity of 25-30%.

Gemcitabine in refractory recurrent SCLC was effective in 13% (median survival 4.25 months).

General principles of modern tactics for the treatment of patients with SCLC can be formulated as follows:

With operable tumors (T1-2 N1 Mo), surgery is possible followed by postoperative combined chemotherapy (4 courses).

The feasibility of using induction chemoradiotherapy and chemoradiotherapy followed by surgery continues to be studied, but there is no convincing evidence of the benefits of this approach.

For inoperable tumors (localized form), combined chemotherapy (4-6 cycles) is indicated in combination with irradiation of the area lung tumors and mediastinum. Maintenance chemotherapy is inappropriate. In case of achieving complete clinical remission - prophylactic irradiation of the brain.

In the presence of distant metastases (a common form of SCLC), combined chemotherapy is used, radiation therapy is carried out according to special indications (metastases to the brain, bones, adrenal glands).

Currently, the possibility of curing about 30% of patients with SCLC in the early stages of the disease and 5-10% of patients with inoperable tumors has been convincingly proven.

The fact that in last years A whole group of new anticancer drugs active in SCLC has appeared, which allows us to hope for further improvement of therapeutic regimens and, accordingly, improved treatment results.

References for this article are provided.
Please, introduce yourself.

Cancer is a malignant neoplasm that destroys healthy cells of the body as a result of mutation. According to the International Agency for Research on Cancer, its most common location is the lungs.

According to its morphology, lung cancer is divided into non-small cell (including adenocarcinoma, squamous, large cell, mixed) - about 80-85% of the total incidence, and small cell - 15-20%. Currently, there is a theory of the development of small cell lung cancer as a result of the degeneration of the cells of the epithelial lining of the bronchi.

Small cell lung cancer is the most aggressive, characterized by early metastasis, latent course and the most unfavorable prognosis, even in the case of treatment. Small cell lung cancer is the most difficult to treat, in 85% of cases it ends fatally.

The early stages are asymptomatic and are more often diagnosed incidentally. preventive examinations or going to the clinic with other problems.

Symptoms may indicate a need for testing. The appearance of symptoms in the case of SCLC may indicate an already advanced stage of lung cancer.

Reasons for development

• Small cell lung cancer is directly related to smoking. Longtime smokers are 23 times more likely to develop lung cancer than non-smokers. 95% of patients with small cell lung carcinoma are male smokers over 40 years of age.
• Inhalation of carcinogenic substances - work in "harmful" industries;
• Unfavorable ecological situation;
• Frequent or chronic diseases lungs;
• Weakened heredity.

Not smoking is the best prevention for small cell lung cancer.

Symptoms of lung cancer

• Cough;
• Dyspnea;
• Noisy breathing;
• Deformity of the fingers "drumsticks";
• Dermatitis;
• Hemoptysis;
• weight loss;
• Symptoms of general intoxication;
• Temperature;
• In the 4th stage - obstructive pneumonia, secondary signs appear from the affected organs: bone pain, headaches, confused consciousness.

Signs of pathology may differ depending on the location of the initial neoplasm.

Small cell carcinoma is more often central than peripheral. Moreover, the primary tumor is radiographically detected extremely rarely.

Diagnostics

When identifying the primary signs of pathology on fluorography and clinical indications(smoking, heredity, age over 40, gender, etc.) informative methods diagnostics recommended in pulmonology. Main diagnostic methods:

1. Visualization of the tumor by radiation methods: radiography, computed tomography (CT), positron emission tomography (PET-CT).
2. Determination of tumor morphology (i.e. its cellular identification). To conduct a histological (cytological) analysis, a puncture is taken using bronchoscopy (which is also a non-radiation imaging method), and other methods of obtaining material.

SCLC stages

1. Neoplasm less than 3 cm in size (measured in the direction of maximum elongation), located in one segment.
2. Less than 6 cm, not extending beyond one segment of the lung (bronchus), single metastases in nearby lymph nodes
3. More than 6 cm, affects the near lobes of the lung, the adjacent bronchus, or exits into the main bronchus. Metastases spread to distant lymph nodes.
4. Cancer neoplasia can go beyond the lung, with growth in neighboring organs, multiple distant metastasis.

International TNM classification

Where T is an indicator of the state of the primary tumor, N - regional lymph nodes, M - distant metastasis

T x - data are insufficient to assess the state of the tumor, or it has not been detected,

T 0 - the tumor is not identified

TIS- non-invasive cancer

and from T 1 to T 4 - stages tumor growth from: less than 3 cm, to a value where the size does not matter; and stages of location: from local in one lobe, to the capture of the pulmonary artery, mediastinum, heart, carina, i.e. before growing into neighboring organs.

N is an indicator of the state of regional lymph nodes:

N x - data are insufficient to assess their condition,

N 0 - no metastatic lesion was found

N 1 - N 3- characterize the degree of damage: from nearby lymph nodes to those located on the side opposite the tumor.

M - the state of distant metastasis:

M x - insufficient data to determine distant metastases,

M0- no distant metastases were found

M 1 - M 3 - dynamics: from the presence of signs of a single metastasis, to going beyond the chest cavity.

More than 2/3 of patients are stage III-IV, so SCLC continues to be considered according to the criteria of two significant categories: localized or widespread.

Treatment

In the case of this diagnosis, the treatment of small cell lung cancer directly depends on the degree of damage to the organs of a particular patient, taking into account his history.

Chemotherapy in oncology is used to form the boundaries of the tumor (before it is removed), in postoperative period to destroy possible cancer cells and as an essential part of the treatment process. It should reduce the tumor, radiation therapy should fix the result.

Radiation therapy is ionizing radiation that kills cancer cells. Modern devices generate narrow beams that minimally injure nearby areas of healthy tissue.

The need and sequence of surgical methods and therapeutic methods is determined directly by the attending oncologist. The goal of therapy is to achieve remission, preferably complete.

Therapeutic procedures - early stages

Surgical surgical intervention- unfortunately, the only way to date to remove cancer cells. The method is used at stages I and II: removal of the entire lung, lobe or part of it. Postoperative chemotherapy is a mandatory component of treatment, usually with radiation therapy. In contrast to non-small cell lung cancer, in the initial stage of which it is possible to confine oneself to tumor removal /. Even in this case, the 5-year survival does not exceed 40%.

The chemotherapy regimen is prescribed by an oncologist (chemotherapist) - medications, their dosage, duration and their number. Evaluating their effectiveness and based on the patient's well-being, the doctor can adjust the course of treatment. As a rule, antiemetic drugs are additionally prescribed. Various alternative treatments, dietary supplements, including vitamins, can worsen your condition. It is necessary to discuss their reception with the oncologist, as well as any significant changes in your health.

Medical procedures – 3,4 stages

The usual scheme for localized forms of more complex cases is combined therapy: polychemotherapy (poly means the use of not one, but a combination of drugs) - 2-4 courses, it is advisable in combination with radiation therapy for the primary tumor. When remission is achieved, prophylactic irradiation of the brain is possible. Such therapy increases life expectancy by an average of 2 years.

With a common form: polychemotherapy 4-6 courses, radiation therapy - according to indications.

In cases where tumor growth has stopped, we speak of partial remission.

Small cell lung cancer responds very well to chemotherapy, radiotherapy, and radiotherapy. The insidiousness of this oncology is the high probability of relapses, which are already insensitive to such antitumor procedures. Possible course of recurrence - 3-4 months.

Metastasis occurs (cancer cells are carried with the bloodstream) to organs that are most intensively supplied with blood. The brain, liver, kidneys, adrenal glands suffer. Metastases penetrate the bones, which, among other things, leads to pathological fractures and disability.

If the above methods of treatment are ineffective or impossible (due to age and individual features patient) undergoing palliative care. It is aimed at improving the quality of life, mainly symptomatic, including pain relief.

How long do people live with SCLC

Life expectancy directly depends on the stage of the disease, your general health and the methods of treatment used. According to some reports, women have better sensitivity to treatment.

A short-term illness can give you 8 to 16 weeks if you are unresponsive to or refuse therapy.

The treatments used are far from perfect, but it increases your chances.

In the case of combined treatment in stages I and II, the probability of a 5-year survival (after five years it is said about complete remission) is 40%.

At more serious stages, life expectancy with combination therapy increases by an average of 2 years.

In patients with localized tumor (i.e. not early stage, but without distant metastasis) using complex therapy 2-year survival - 65-75%, 5-year survival is possible in 5-10%, with good health - up to 25%.

In the case of advanced SCLC - 4 stages, survival up to a year. The prognosis of a complete cure in this case: cases without relapses are extremely rare.

Afterword

Someone will look for the causes of cancer, not understanding what it is for him.

Believers endure the disease more easily, perceiving it as a punishment or test. Perhaps this makes them feel better, and may it bring peace and strength of mind in the struggle for life.

A positive attitude is essential for a favorable treatment outcome. Only how to find the strength to resist pain and remain yourself. It is impossible to give the right advice to a person who has heard a terrible diagnosis, as well as to understand it. It's good to have family and friends help you.

(No ratings yet)

Approximately 20% of the total number of diseases. Over the past few years, the number of patients has decreased. This is partly due to the fact that the composition of cigarettes and the air inhaled have changed. The disease in most cases appears from smoking.

General information about the disease

Small cell refers to malignant tumors, accompanied by an aggressive course and metastasis. The metastatic process is very active. Already in the early stages of the disease, metastases can be detected in the lymph nodes. 95-100% of lesions occur in the intrathoracic nodes, 20-45% in the liver, 17-55% in the adrenal glands, 30-45% in the bones, and up to 20% in the brain.

The choice of oncology treatment method depends on the type of metastasis. According to statistics, 90% of patients are men. The age of patients varies from 38 to 65 years. To live with such a diagnosis to the patient from a year to 5 years. In medicine, there are 2 types of small cell cancer:

1. Mixed carcinoma.
2. Small cell carcinoma.

Small cell to other body tissues. It is called oat cell because of the specificity of the type of cellular structure. Lung adenocarcinoma is characterized by slow growth, but is still considered one of the most aggressive forms of cancer. Small cell carcinoma is also known as low-grade neuroendocrine carcinoma.

Most often, this disease belongs to the first type. There is also a two-stage classification of pathology:

1. Localized process, which is limited to one side of the lung. As a rule, the disease is in stages 1, 2 or 3.
2. A common form of oncology (the disease is at stage 4).

There are a number of factors causing the appearance malignant disease:

1. Tobacco smoking. The likelihood of the onset of the disease is affected by the age of the smoker, the number of cigarettes smoked per day, the quality of tobacco, and the time of smoking. Even if a person gives up smoking, he will still remain at risk. Smokers with SCLC are 2 times more than non-smokers. Those who smoke from adolescence onwards are 32 times more likely to have the disease.
2. Heredity. A person's blood may contain a specific gene that provokes the appearance of lung cancer. Those whose parents or close relatives had small cell cancer are especially likely to get the disease.
3. environmental factors. Waste from enterprises, heavy metals enter the body with air, thereby causing harm to health.
4. Harmful working conditions. People who have prolonged contact with toxic substances, such as nickel, asbestos, arsenic, chromium, suffer from oncology more often than representatives of other professions.

Signs of pathology

The oncological process in this case is specific in that it proceeds almost asymptomatically until the neoplasm is localized in the lungs. The course of the disease is characterized common symptoms characteristic of a wide range of diseases. Among the symptoms characteristic of the early stage of the course of the disease, one can distinguish:

• the presence of a cough;
• hoarse breathing;
• pain in the chest area.

Later symptoms of the course of the disease include:

• coughing up blood;
• headaches;
• back pain;
• hoarseness in the voice;
• difficulty swallowing.

The most characteristic symptom of SCLC is a persistent cough that is difficult to control. It is later accompanied painful sensations in the chest and is expectorated with bloody discharge. A specific sign of SCLC is the presence of shortness of breath along with a cough. This is due to impaired functioning in the vessels and capillaries of the lungs.

Stages 2 and 3 are characterized by the appearance of fever, elevated body temperature, which is difficult to bring down. Pneumonia can be a precursor to cancer. Bleeding from the lungs is an unfavorable symptom, which indicates that the tumor has grown into the pulmonary vessels. This is a sign of advanced disease.

An increase in the tumor leads to the fact that neighboring organs also begin to suffer due to oppression. As a result, a person may feel pain in the back, limbs, swelling in the arms and face, hiccups that cannot be stopped. Metastases affecting organs give additional symptoms.

If the liver is affected, jaundice, pain in the ribs may appear. The metastatic process in the brain leads to numbness of the limbs up to paralysis. Bone metastases are accompanied by aching joints. In addition, a person begins to lose weight rapidly, there is a feeling of fatigue and lack of strength.

Diagnosis of the disease

Before a direct diagnosis of cancer, the doctor examines the patient, listens to the lungs, and collects an anamnesis. Among the procedures aimed at, we can distinguish:

• scintigraphy of the bones of the skeleton;
• radiography of the chest area;
• complete blood count;
• computed tomography;
• analysis of the functioning of the liver;
• magnetic resonance imaging;
• positron emission tomography;
• sputum analysis;
• pleurocentesis.

Taking into account the peculiarities of the clinical course, mandatory methods of examination (fibrobronchoscopy, computed tomography of the lungs, ultrasound procedure regional zones, abdominal cavity and retroperitoneal space) of patients with a morphologically confirmed diagnosis include radionuclide diagnostics of skeletal bones, laboratory examination of the bone marrow and brain tomography.

Treatment Methods

AT official medicine small cell lung cancer is treated with the following techniques:

1. Operational intervention. This type of treatment is indicated only in the early stages of the disease. After the operation, the patient undergoes a course of chemotherapy. For patients in this group, the predicted life expectancy is more than 5 years (in 40% of patients).
2. Radiation therapy. With the successful application of the method, the tumor regresses in 70-80% of patients, but life expectancy does not increase if applied alone.
3. . In the treatment of small cell lung cancer, this method is not so effective. Only 30-45% of patients report improvement.

Treatment may vary depending on the type of disease.. With a localized form of cancer, the effectiveness of treatment is observed in 65-90% of patients. Life expectancy is over 2 years.

If a patient has a localized form of cancer, they may be given radiation therapy with chemotherapy. When the patient improves, then he is additionally given brain irradiation. With the combined method of treatment, the two-year survival rate is 40-45%, the five-year survival rate is 25%. For patients suffering from a common form of SCLC, chemotherapy is performed, radiation therapy is done only on the recommendation of a doctor. The efficiency of this method is about 70%.

When asked how long they live with this disease, the answer is ambiguous. If the patient started therapy at the initial stage, his survival can reach 5 years. Treatment of small cell lung cancer depends on the stage of the disease, its form, and the condition of the patient. The choice of method is the main part that determines the success of therapy in general.

Lung cancer ranks first in terms of frequency of diagnosis among all oncological diseases. The most aggressive form of lung cancer is small cell lung cancer, which is characterized by a latent course of the disease, early metastasis, and poor prognosis.

What is small cell lung cancer

Small cell carcinoma is a neoplasm of malignant origin, which is localized in the human respiratory apparatus. This neoplasm can initially be divided into two types - small cell carcinoma of the left and right lung. The name of this disease can be explained by the size of cellular structures, which have a small value exceeding the size of blood cells (erythrocytes) only 2 times.

Leading clinics in Israel

Small cell cancer is less common than non-small cell cancer (diagnosed in 80% of cases). Often this pathology observed in smoking men aged 50-62 years. Due to the increase in the number of female smokers, the number of cases among women is also increasing.

The tumor almost always begins as a central cancer, this type is fleeting - it spreads very quickly, seeding the entire lung tissue, forming metastases in neighboring organs. This type of lung cancer is an intensively proliferating subspecies of tumors with a high potential for malignancy. Metastases affect not only the organs of the retroperitoneal space and lymph structures, but also the brain.

The basis of this type of oncology is the cancerous degeneration of the epithelium of the lung tissue, the violation of air exchange. This type of lung cancer is the most difficult to treat, it ends fatally in 85% of cases.

Related video:

Causes

The causes of tumor pathogenesis can be:

• smoking. This is the root cause of the beginning of the transformation of the structure of lung tissue cells;
• heredity (the presence in the history of a similar disease in relatives increases the risk of getting this disease);
• unfavorable ecology in the patient's area of ​​residence;
• previous severe lung diseases (asthma, chronic obstructive pulmonary disease, pulmonary tuberculosis, etc.) infectious diseases and pathological neoplasms).
• prolonged contact with carcinogens (arsenic, nickel, chromium). Contacting is possible both in places of residence and at the place of work;
• the impact on the body of radioactive ions (for example, it is possible during various man-made disasters);
• asbestosis of the lungs;
• dust impact;
• influence of radon.

Symptoms of the disease

At the initial stages of formation, small cell carcinoma is not expressed by specific symptoms, the symptoms can be disguised as other pathologies of the lung system. But with the further spread of small cell lung cancer, its rapid metastasis, the symptoms begin to be clearly traced and become noticeable.

In the early stages, this type of lung cancer can be suspected only by some indirect signs:

• cough (in the initial stages, dry and lingering, later acquiring a paroxysmal character and becoming hacking, with sputum and bloody secretions);
• pain in the chest area;
• mediastinal compression;
• causeless shortness of breath that occurs from time to time;
• weakness, general malaise;
• severe loss of appetite, sudden weight loss, cachexia;
• possibly reduced vision;
• there is hoarseness when breathing, hoarseness in the voice when talking (dysphonia).

With late diagnosis, metastases of this cancer spread and the clinical picture is supplemented by the following symptoms:

• intense headaches of a different nature (pulsating and pulling, localized in one place, up to migraine-like tingling, which cover the entire head);
• pain localized in the area of ​​the entire back, often radiating to the projection of the spine, pain in the bones, aching joints (this is due to metastases to the bone tissue).

On the final stages, with the involvement of mediastinal tissues in the cancerous process, a mediastinal compression syndrome develops, consisting of:

• dysphagia (eating disorders, when it becomes difficult for the patient to swallow food or it is simply impossible);
• hoarseness of voice (appears with paralysis of the laryngeal nerve);
• abnormal swelling of the neck and face (usually unilateral, appears when the superior vena cava is compressed).

With metastases in the liver, icterus is possible skin and development of hepatomegaly. There may be hyperthermic manifestations, paraneoplastic syndrome (Lambert-Eaton myasthenic syndrome, secretory disorder of antidiuretic hormone syndrome, Cushingoid manifestations).

At stage 4, there is a speech disorder and high-intensity headaches occur, noisy breathing, dermatitis may appear, deformation of the fingers in the image is observed. drumsticks”, symptoms of general intoxication, temperature increases, obstructive pneumonia, confused consciousness occurs.

Signs of pathology may vary depending on the location of the initial neoplasm.

Small cell carcinoma is usually central, less common peripheral. A primary tumor (as opposed to a secondary neoplasm) is detected extremely rarely by radiographic method.

Stages of the disease and types of cancer

The division of small cell carcinoma according to the TNM classification has no fundamental differences and consists in the following positions: T - shows the state of the primary neoplasm, N - the state of regional lymph nodes, M - the presence and absence of distant metastasis.

A clear division into stages helps to determine the methods of treating a neoplasm - surgical or therapeutic.

Stage 1 - the size of the tumor is within 3 cm, the tumor affects one lung, there are no metastases.

Stage 2 - the size of the neoplasm is 3-6 cm, it blocks the bronchus and penetrates the pleura, causing atelectasis;

Stage 3 - cancer quickly spreads to neighboring organs, the tumor grows up to 6-7 cm, there is atelectasis of the entire lung, there are metastases in neighboring lymph nodes.

Stage 4 - malignant cells are present in distant organs.

More than half of patients are diagnosed with stage 3 or 4, so this type of cancer is considered according to the criteria for two important categories: localized (limited) or advanced type of cancer:

• the localized form involves only one lung in the process (they share the right-sided and left-sided forms);
• a common variant (it is comparable to stages 3-4 according to the TNM system) occurs in 60-65% of cases. It covers the two parts of the chest together with the tumor process, with the addition of cancerous pleurisy and the rapid appearance of metastases.

According to histology, lung cancer is divided into the following types:

Squamous cell (epidermoid) cancer, which has subspecies:

• highly differentiated;
• moderately differentiated;
• undifferentiated.

small cell cancer it happens:

• oat cell, fine-grained, spindle cell;
• intermediate (intercellular);
• pleomorphic (multicellular).

Adenocarcinoma subdivided into:

• highly differentiated;
• moderately differentiated;
• poorly differentiated (low-differentiated);
• bronchoalveolar.

Large cell cancer has two subspecies:

• clear cell;
• giant cell.

mixed type cancer happens:

• adenocarcinoma and small cell;
• squamous and adenocarcinoma, etc.

The histological characterization is rather conditional, since clinical course may differ even in tumors with the same structure.

Don't waste time searching uselessly for inaccurate cancer treatment prices

* Only on condition of obtaining data on the patient's disease, the clinic representative will be able to calculate the exact price for the treatment.

Diagnosis of the disease

Various instrumental and laboratory research, consisting of:

• chest x-ray;
• MRI, PET, computed tomography(CT);
• skeletal scintigraphy;
• analyzes of the functioning of the liver;
• blood test;
• sputum analysis (cytological examination to detect cancer cells);
• thoracentesis (fluid collection from the chest cavity near the lungs);
• measurements of IAP (intra-abdominal pressure);
• analysis for tumor markers;
• biopsies of neoplasms or nearby lymph nodes.

There are several ways to do a biopsy, using:

• bronchoscopy;
• endoscopic ultrasound;
• mediastinoscopy.

Also perform:

• pleural biopsy;
• open lung biopsy;
• videothoracoscopy.

Treatment of small cell lung cancer

The main methods of treatment of this cancer are: polychemotherapy and radio irradiation. Surgical intervention makes sense to carry out only in the early stages.

Therapy for lung cancer is also carried out by other methods of treatment:

• immunotherapy
• brachytherapy;
• photodynamic therapy;
• targeted therapy;
• laser coagulation;
• radiofrequency ablation;
• cryodestruction;
• chemoembolization;
• radioembolization;
• biotherapy.

Each of these methods may be applicable in the treatment of lung cancer.

The goal of therapy for small cell lung cancer is to achieve absolute remission, which is confirmed by biopsy, bronchial examination (bronchoscopy), bronchoalveolar lavage. The effectiveness of treatment can be assessed after 6-12 weeks from the start of therapy, and then a life expectancy forecast can be made.

Chemotherapy is considered to be the most effective treatment for lung cancer. independent method treatment, and as an adjunct to radiation exposure. Women are more sensitive to treatment.

Therapy with chemotherapy drugs is used only when neither chemotherapy nor radiotherapy has been performed before, there are no concomitant serious illnesses, heart and liver failure, and bone marrow potential within the normal range. If the patient's condition does not meet these indicators, the dosage of chemotherapy drugs is reduced in order to avoid severe side effects.

Chemotherapy for small cell cancer is effective at any stage - at early stages it can prevent the spread of metastases, in the latter it helps to alleviate the course of the disease and prolong the life of the patient. To suppress tumor angiogenesis, Avastin is also used, which affects this process of tumor development by binding to the VEGF protein.

A limited form of neoplasm of the lung (right or left) needs a small number (2-4) of chemotherapy courses. Cytostatic drugs are commonly used: Doxorubicin, Cyclophosphamide, Gemcitabine, Cisplatin, Etoposide, Vincristine and others. Cytostatics are used as monotherapy or in combination with irradiation of the primary tumor site. In remission, radioirradiation of the brain is additionally performed to reduce the risk of metastatic seeding.

Combination therapy for a limited form of small cell cancer offers a chance to extend life up to 2 years. With a common form of lung cancer, the number of chemotherapy courses increases to 4-6. In the presence of metastases in nearby and distant organs (adrenal glands, skeletal system, brain and others) chemotherapy is accompanied by radiotherapy.

Drug (palliative) treatment is more often used to maintain the vital activity of already affected organs and alleviate the patient's condition. This type of treatment is supportive. Preparations of various pharmacological groups are used:

• pain medications (including narcotic drugs),
• anti-inflammatory drugs;
• antibiotic agents to prevent infection and exacerbation of the disease;
• drugs to protect the liver ("Essentiale");
• means for supplying oxygen to cell structures ("Pantogam", "Glycine") - in case of damage to brain cells;
• lowering the temperature ("Nimesulide", "Paracetamol", "Ibuprofen") with hyperthermia.

Surgical intervention for small cell carcinoma is carried out at stages 1-2 and must be accompanied by a course of postoperative polychemotherapy. With excision of malignant tissues of the organ, life expectancy increases. If this lung cancer is determined in the last stages with the coverage of the cancerous process of other organs, surgical treatment is not performed due to the increased risk of death during the operation. In addition to the classic method of tumor removal, sparing surgery using a CyberKnife can be used.

Treatment of localized small cell carcinoma and prognosis

With the treatment of this form of cancer, the prognosis is as follows:

• tumor regression occurs in 45-75% of cases;
• the effectiveness of therapy - 65-90%;
• 2-year survival - 40-50%;
• The 5-year survival threshold is 10-25% for patients who start treatment in good general health.

The main method of treating a localized form of this cancer is chemotherapy (2-4 courses) in conjunction with radiation therapy. Radiation therapy is performed on the background of chemotherapy or after the patient has received several courses of chemotherapy. During remission, brain irradiation is performed, since this type of cancer has a tendency to quickly and aggressively metastasize to the brain.

Applied therapy regimens:

• combined: chemotherapy and radiation therapy with prophylactic cranial irradiation (PKO) in the presence of remission;
• chemotherapy with or without PCO, for patients with impaired respiratory function;
• surgical resection in conjunction with adjuvant therapy for patients at stage 1;
• combined use of chemotherapy and thoracic radiotherapy - used for patients with a limited stage.

How to treat a common form of small cell cancer

With a common form, combined treatment is carried out, it makes sense to carry out irradiation with the following indicators:

• ongoing process of metastasis in the adrenal glands;
• bone metastases;
• metastasis in the lymph nodes, mediastinum with compression syndrome of the superior vena cava;
• metastases in the brain.

Applied methods of therapy:

• combination chemotherapy with or without cranial radiation;
• "Ifosfamide" along with "Cisplatin" and "Etoposide";
• "Cisplatin" + "Irinotecan";
• a combination of "Etoposide", "Cisplatin" and "Carboplatin";
• "Cyclophosphamide" along with "Doxorubicin", "Etoposide" and "Vincristine";
• a combination of "Doxorubicin" with "Cyclophosphamide" and "Etoposide";
• "Cyclophosphamide" in combination with "Etoposide" and "Vincristine".

Irradiation is used when chemotherapy is not effective, especially for metastases to the spinal cord, brain, or bones.

A combination of "Cisplatin" and "Etoposide" gives a good effect. Although "Cisplatin" often has severe side effects, leading to serious consequences in those with cardiovascular disease. Carboplatin is not as toxic as Cisplatin.

Nutrition in lung cancer, as in other types of oncology, should be gentle and nutritious, it is mandatory to follow a diet, diet and give up bad habits.

The use of folk remedies is possible as an addition to the main treatment and only with the permission of the attending physician. Refusal of the main treatment in favor of traditional medicine can lead to a deterioration in the patient's condition and the transience of the disease, followed by death.

It is useful to drink decoctions from medicinal herbs at the stages of remission, as well as to reduce pain syndromes during the main treatment, informing the doctor.

Want to get a quote for treatment?

*Only subject to obtaining data on the patient's disease, a clinic representative will be able to calculate an accurate estimate for treatment.

How long do people live with small cell lung cancer?

When conducting timely diagnosis and treatment there are chances of recovery.

Transient disease gives about 8-16 weeks of life (after which the patient dies) in case of refusal of treatment or insensitivity to it.

All patients who crossed the 3-year life expectancy threshold belong to the complete remission group, their survival rate can reach 70-92% of the total number of this disease.

If the size of the neoplasm after treatment has decreased by half or more of the original size, then this indicates a partial remission, and the life expectancy of these patients is two times less than the previous one.

Only 5-11% of all patients overcome the five-year survival threshold.

The overall life expectancy depends on:

• timely diagnosis;
• stage of the detected disease;
• high-quality complex treatment;
• postoperative (or after a course of polychemotherapy) observation;
• the general health of the patient.

With combined treatment in stages I and II, the chances of crossing the 5-year threshold are about 40%.

At later stages, with combination therapy, life expectancy increases by an average of two years.

In patients with a localized tumor (not an early stage, but without distant metastasis) with the use of complex therapy, a two-year survival rate of about 65-75%, about 5-10% of patients can overcome the 5-year threshold, with good health, the chances of surviving to 5 years increased in 25% of patients.

In the case of advanced type 4 lung cancer, the survival rate is usually up to 1 year. The prognosis for an absolute cure (without recurrence) is unlikely.