Evidence-based Treatment of a Patient with Extensive Small Cell Lung Cancer_Chinese Journal of Evidence-Based Medicine

Authors：

MI Denghai ^1,2 , JIANG Lei ¹ ,  YANG Kehu ¹ , ZHENG Tong ²

1. Evidence-Based Medicine Center of Lanzhou University, School of Basic Medical Sciences of Lanzhou University, Lanzhou 730000, China;2. Department of tumor therapy center. The second people hospital of Gansu province, Lanzhou 730000, China;

Corresponding author：

YANG Kehu, Email: mi.dh@163.com

Keywords：

Extensive small cell lung cancer; Chemotherapy; Radiotherapy; Evidence-based treatment

DOI：

10.7507/1672-2531.20090089

Video：

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Objective 　The objective of this study is to find individualized, evidence-based treatment for a patient
with extensive small cell lung cancer, malignant pleural effusion, and liver metastasis.
Methods 　According to the PICO (patient intervention comparison outcome) principle, evidence was collected and critically assessed. The patient’s preference was also taken into consideration in the decision making process.
Results　 We included 10 randomized controlled trials, 13 systematic reviews and meta-analyses, and three clinical guidelines. The evidence indicated that chemotherapeutic treatment prolongs survival in patients with extensive small cell lung cancer and AiDi injections could relieve adverse effects caused by chemotherapy or radiotherapy. Cisplatin and etoposide are considered major standard cytotoxic drugs for small cell lung cancer. We drained the pleural cavity and infused Bleomycin into the pleural cavity. We also used an EP regimen of chemotherapy after the patient’s condition had improved. This patient survived longer than the average survival time for small cell lung cancer patients and has enjoyed a higher quality of life.
Conclusion 　Chemotherapy is the main medical treatment for patients with extensive small cell lung cancer, backed up by symptomatic treatment and supportive care. Prophylactic cranial irradiation decreases brain metastases incidence and improves survival in complete response small cell lung cancer patients.

Citation： MI Denghai,JIANG Lei,YANG Kehu,ZHENG Tong. Evidence-based Treatment of a Patient with Extensive Small Cell Lung Cancer. Chinese Journal of Evidence-Based Medicine, 2009, 09(4): 484-488. doi: 10.7507/1672-2531.20090089 Copy

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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, 朱静, 高仲阳. 艾迪注射液联合化疗治疗中晚期肺癌的临床疗效观察. 中国医院药学杂志, 2008, 28(1):51-53.
8.	赵新华, 蒋显勇, 李庆, 等. 艾迪联合化疗治疗晚期肺癌的临床疗效观察. 中华肿瘤防治杂志, 2006, l3(2); l42-143.
9.	莫海鹰, 于新发, 王健. 艾迪注射液治疗晚期肺癌疗效观察. 现代医院, 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. 伊立替康联合顺铂方案与足叶乙甙联合顺铂方案治疗小细胞肺癌的随机对照临床研究. 中国肺癌杂志, 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.

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, 朱静, 高仲阳. 艾迪注射液联合化疗治疗中晚期肺癌的临床疗效观察. 中国医院药学杂志, 2008, 28(1):51-53.
8. 赵新华, 蒋显勇, 李庆, 等. 艾迪联合化疗治疗晚期肺癌的临床疗效观察. 中华肿瘤防治杂志, 2006, l3(2); l42-143.
9. 莫海鹰, 于新发, 王健. 艾迪注射液治疗晚期肺癌疗效观察. 现代医院, 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. 伊立替康联合顺铂方案与足叶乙甙联合顺铂方案治疗小细胞肺癌的随机对照临床研究. 中国肺癌杂志, 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.

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