Mustafa ALTINBAŞ, Mustafa DİKİLİTAŞ, Metin ÖZKAN, Gököz Gamze DOĞU, Özlem ER

Küçük hücreli akciğer kanserine yaklaşım

Küçük hücreli akciğer kanseri (KHAK) biyolojik davranışı, tedavi şekli ve prognozu açısından küçük hücreli dışı akciğer kanserlerinden ayrılır. Tanı anında çoğunlukla yaygın hastalık evresinde olması, uzak organ metastazı ve bölgesel lenf bezi tutulumu bulunması nedeniyle sistemik bir hastalık kabul edilir. Hastalığın genetik ve moleküler özelliklerini anlamaya yönelik çalışmalar sonuçlandığında tedavi yaklaşımlarımız değişebilecektir. Yeni ve daha etkin tedavi arayışlarına karşın sınırlı hastalık evresinde 15 yıldır kemoterapi standartı değişmemiştir. Yaygın hastalıkta yeni tedavi arayışları ise sürmektedir. Akciğer kanseri için sigara ile mücadele hala en etkili yöntemdir.

Approach to small cell lung cancer

Small cell lung cancer (SCLC) is distinguished by non-small cell lung cancer (NSCLC) by its' biological behaviour, management and prognosis. As the disease is commonly in extended form and distant metastasis and regional lymph node involvement are present at the time of diagnosis SCLC is assumed as a systemic disease. Studies concerning with understanding the molecular and genetic characteristics of the disease may change the treatment modalities. Despite the efforts to develope new and effective treatment options, standart management of limited disease remained unchanged during the last fifteen years. On the other hand there are ongoing studies for the treatment of extended disease. However, prevention of cigarette smoking is still the best practice.

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1) Page NC. Epidemiology of SCLC, ASCO 2002.
2) Ettinger DS. New drugs for chemotherapy-naive patients with extensive disease small cell lung cancer. Semin Oncol 2001;28(2 Suppl 4):27-9.
3) Wolf M. Kleinzellige Bronchialkarzinome. Klinische Praesentation. Diagnostik und prognostische Faktoren. Onkologe 1998;4:1005-18.
4) Murren J, et al. Cancer. In: DeVita VT, Hellman S, Rosenburg SA, editors. Cancer. Principles & practice of oncology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p. 983-1018.
5) Ihde DC, et al. Cancer. Principles & Practice of Oncology. 1997. p. 911-48.
6) Adapted from Lassen U, Hansen HH. Cancer treatment. 4th ed. 1995.
7) Jackman DM, Johnson BE. Small-cell lung cancer. Lancet 2005;366(9494):1385 96.
8) Pretreatment evaluation of non-small-cell lung cancer. The American Thoracic Society and The European Respiratory Society. Am J Respir Crit Care Med 1997;156(1):320-32.
9) Hauber HP, Bohuslavizki KH, Lund CH, Fritscher- Ravens A, Meyer A, Pforte A. Positron emission tomography in the staging of small-cell lung cancer : a preliminary study. Chest 2001;119(3):950-4.
10) Johnson BE, Chute JP, Rushin J, Williams J, Le PT, Venzon D, et al. A prospective study of patients with lung cancer and hyponatremia of malignancy. Am J Respir Crit Care Med 1997;156(5):1669-78.
11) Lassen U, et al. Cancer treatment. 1995. p. 414-420.
12) Soriano AF, et al. Current Cancer Therapeutics. 1998. p. 177-191.
13) Manegold C. Chemotherapie des kleinzelligen Bronchialkarzinoms. Onkologe 1998;4:1019-29.
14) Pignon JP, Arriagada R, Ihde DC, Johnson DH, Perry MC, Souhami RL, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992;327(23):1618-24.
15) Takada M, Fukuoka M, Kawahara M, Sugiura T, Yokoyama A, Yokota S, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limitedstage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 2002;20(14):3054-60.
16) Tsukada H, Yokoyama A, Goto K, Takada M, Saijo N; Japan Clinical Oncology Lung Cancer Study Group. Concurrent versus sequential radiotherapy for small cell lung cancer. Semin Oncol 2001;28(2 Suppl 4):23-6.
17) Auperin A, Arriagada R, Pignon JP, Le Pechoux C, Gregor A, Stephens RJ, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 1999;341(7):476-84.
18) Klasa RJ, Murray N, Coldman AJ. Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung. J Clin Oncol 1991;9(3):499- 508.
19) Chouaid C, Bassinet L, Fuhrman C, Monnet I, Housset B. Routine use of granulocyte colony-stimulating factor is not cost-effective and does not increase patient comfort in the treatment of small-cell lung cancer: an analysis using a Markov model. J Clin Oncol 1998;16(8):2700-7.
20) Sandler AB. Current management of small cell lung cancer. Semin Oncol 1997;24(4):463-76.
21) Janne PA, Freidlin B, Saxman S, Johnson DH, Livingston RB, Shepherd FA, et al. Twenty-five years of clinical research for patients with limited-stage small cell lung carcinoma in North America. Cancer 2002;95(7):1528-38.
22) Green RA, Humphrey E, Close H, Patno ME. Alkylating agents in bronchogenic carcinoma. Am J Med 1969;46(4):516-25.
23) Lowenbraun S, Bartolucci A, Smalley RV, Lynn M, Krauss S, Durant JR. The superiority of combination chemotherapy over single agent chemotherapy in small cell lung carcinoma. Cancer 1979;44(2):406-13.
24) Medical Working RCLC Group. BJCancer 1979;40:1- 10.
25) Roth BJ, Johnson DH, Einhorn LH, Schacter LP, Cherng NC, Cohen HJ, et al. Randomized study of cyclophosphamide, doxorubicin, and vincristine versus etoposide and cisplatin versus alternation of these two regimens in extensive small-cell lung cancer: a phase III trial of the Southeastern Cancer Study Group. J Clin Oncol 1992;10(2):282-91.
26.ASCO 1994;13:333.
27) Lebeau B, Chastang C, Brechot JM, Capron F. A randomized trial of delayed thoracic radiotherapy in complete responder patients with small-cell lung cancer. Petites Cellules Group. Chest 1993;104(3):726-33.
28) Turrisi AT 3rd, Kim K, Blum R, Sause WT, Livingston RB, Komaki R, et al. Twice-daily compared with oncedaily thoracic radiotherapy in limited small cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 1999;340(4):265-71.
29) Sundstrom S, Bremnes RM, Kaasa S, Aasebo U, Hatlevoll R, Dahle R, et al. Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up. J Clin Oncol 2002;20(24):4665-72.
30) Mascaux C, Paesmans M, Berghmans T, Branle F, Lafitte JJ, Lemaitre F, et al. 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.
31) 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.
32) Maurer LH, Tulloh M, Weiss RB, Blom J, Leone L, Glidewell O, et al. A randomized combined modality trial in small cell carcinoma of the lung: comparison of combination chemotherapy-radiation therapy versus cyclophosphamide-radiation therapy effects of maintenance chemotherapy and prophylactiv whole brain irradiation. Cancer 1980;45(1):30-9.
33) Cullen M, Morgan D, Gregory W, Robinson M, Cox D, McGivern D, et al. Maintenance chemotherapy for anaplastic small cell carcinoma of the bronchus: a randomised, controlled trial. Cancer Chemother Pharmacol 1986;17(2):157-60.
34) Pawel J, et al. J Clin Oncol 1999;17:658-67.
35) Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A, 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.
36) Hanna NH, Einhorn L, Sandler A, et al. ASCO 2005. [abs 7004]
37) Eckardt JR, et al. ASCO LBA 7003, 2005.
38) Quoix E, Breton JL, Gervais R, Wilson J, Schramel F, Cardenal F, et al. A randomised phase II study of the efficacy and safety of intravenous topotecan in combination with either cisplatin or etoposide in patients with untreated extensive disease small-cell lung cancer. Lung Cancer 2005;49(2):253-61.
39) Ardizzoni A, Manegold C, Debruyne C, Gaafar R, Buchholz E, Smit EF, et al. European organization for research and treatment of cancer (EORTC) 08957 phase II study of topotecan in combination with cisplatin as second-line treatment of refractory and sensitive small cell lung cancer. Clin Cancer Res 2003;9(1):143-50.