Dose-Intensive Therapy in Small Cell Lung Cancer

摘要: Basic to curative treatment for small cell lung cancer (SCLC) are the principles of dose response, combination chemotherapy, and combined-modality therapy. Theory experimental clinical data suggest that solid tumors recur, despite initially responding chemotherapy due drug resistance. Resistance is potentially overcome by using 5- 10-fold higher doses. To decrease emergence resistance, combinations active non-cross-resistant agents used. Hematopoietic stem support provides opportunity test response limits organ tolerance. Dose-intensive therapy patients complicated fact this disease most often occurs in an older-aged population (median, 60 65 years) with underlying smoking-related comorbid disease, early metastatic spread, enhanced risk secondary malignancies. In a phase II feasibility trial just activated, younger than years age limited-stage SCLC being treated four cycles cisplatin etoposide concurrent twice-daily chest radiotherapy 45 Gy (150-cGy fractions). Those achieving complete or near-complete will receive high-dose cyclophosphamide/cisplatin/carmustine autologous support. Upon recovery, prophylactic cranial irradiation be given. Results could lead III testing concept intensification. This article reviews evidence contribution intensification survival SCLC, adequacy trial's design address these relationships, suggestions future directions. The strategies dose-intensive induction therapy, multicycle therapies, radiography, purging trials discussed.