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指南阅读

小细胞肺癌全身治疗原则NCCN指南2017第2版

发表者:张品良 599人已读

PRINCIPLES OF SYSTEMIC THERAPY 全身治疗原则

The regimens included are representative of the more commonly used regimens for small cell lung cancer. Other regimens may be acceptable.山东省肿瘤医院呼吸内科张品良
治疗方案包括有代表性的更常用的小细胞肺癌治疗方案。其他方案也是可接受的。

Systemic therapy as primary or adjuvant therapy:
全身治疗作为初始或辅助治疗:

* Limited stage (maximum of 4–6 cycles):
*局限期(最多4-6周期):

Cisplatin 60 mg/m2 day 1 and etoposide 120 mg/m2 days 1, 2, 3
顺铂60mg/ d1,依托泊苷120mg/ d123

Cisplatin 80 mg/m2 day 1 and etoposide 100 mg/m2 days 1, 2, 3
顺铂80mg/ d1,依托泊苷100mg/ d123

Carboplatin AUC 5–6 day 1 and etoposide 100 mg/m2 days 1, 2, 3
卡铂AUC 5-6 d1,依托泊苷100mg/ d123

During systemic therapy + RT, cisplatin/etoposide is recommended  (category 1).
在全身治疗+放疗期间,推荐顺铂/依托泊苷(1类)。

The use of myeloid growth factors is not recommended during concurrent systemic therapy plus radiotherapy (category 1 for not using GM-CSF).
在同步全身治疗加放疗期间不推荐使用骨髓生长因子(对于不使用GM-CSF 1类)。

Bunn PA, Crowley J, Kelly K, et al. Chemoradiotherapy with or without granulocyte-macrophage colony-stimulating factor in the treatment of limited-stage small-cell lung cancer: a prospective phase III randomized study of the Southwest Oncology Group. J Clin Oncol 1995;13:1632-1641.
Bunn PA, Crowley J, Kelly K,等。放化疗加或不加粒细胞-巨噬细胞集落刺激因子治疗局限期小细胞肺癌:西南肿瘤学组的一项前瞻性III期随机研究。J Clin Oncol 1995;13:1632-1641.

* Extensive stage (maximum of 4–6 cycles):
*广泛期(最多4-6周期):

Carboplatin AUC 5–6 day 1 and etoposide 100 mg/m2 days 1, 2, 3
卡铂AUC 5-6 d1,依托泊苷100mg/ d123

Cisplatin 75 mg/m2 day 1 and etoposide 100 mg/m2 days 1, 2, 3
顺铂75mg/ d1,依托泊苷100mg/ d123

Cisplatin 80 mg/m2 day 1 and etoposide 80 mg/m2 days 1, 2, 3
顺铂80mg/ d1,依托泊苷80mg/ d123

Cisplatin 25 mg/m2 days 1, 2, 3 and etoposide 100 mg/m2 days 1, 2, 3
顺铂25mg/ d123,依托泊苷100mg/ d123

Carboplatin AUC 5 day 1 and irinotecan 50 mg/m2 days 1, 8, 15
卡铂AUC 5 d1,伊立替康50mg/ d1815

Cisplatin 60 mg/m2 day 1 and irinotecan 60 mg/m2 days 1, 8, 15
顺铂60mg/ d1,伊立替康60mg/ d1815

Cisplatin 30 mg/m2 and irinotecan 65 mg/m2 days 1, 8
顺铂30mg/ d1,伊立替康65mg/ d18

 

Subsequent systemic therapy:
后续全身治疗:

* Clinical trial preferred.
*首选临床试验。

* Relapse 6 mo, PS 0-2:
*复发≤6个月,PS 0-2:

topotecan PO or IV
拓扑替康 POIV

irinotecan
伊立替康

paclitaxel
紫杉醇

docetaxel
多西他赛

temozolomide
替莫唑胺

nivolumab ± ipilimumab
尼鲁单抗±伊匹单抗

vinorelbine
长春瑞滨

oral etoposide
口服依托泊苷

gemcitabine
吉西他滨

cyclophosphamide/doxorubicin/vincristine (CAV)
环磷酰胺/阿霉素/长春新碱(CAV

bendamustine (category 2B)
苯达莫司汀(2B类)

* Relapse >6 mo: original regimen
*复发>6个月:原方案

Consider dose reduction or growth factor support for patients with PS 2
对于PS 2的患者考虑减量或生长因子支持

Response assessment
疗效评估

* Limited-stage
*局限期

For patients receiving adjuvant therapy, response assessment should occur only after completion of initial therapy; do not repeat scans to assess response during adjuvant treatment.
对于接受辅助治疗的患者,只有在完成初始治疗后才应该评估疗效;在辅助治疗期间不要为了评估疗效重复扫描。

For patients receiving systemic therapy + concurrent RT, response assessment should occur only after completion of initial therapy; do not repeat scans to assess response during initial treatment.
对于接受全身治疗+同步放疗的患者,只有在完成初始治疗后才应该评估疗效;在初始治疗期间不要为了评估疗效而重复扫描。

For patients receiving systemic therapy alone or sequential systemic therapy followed by RT, response assessment by CT chest/liver/adrenal with contrast should occur after every 2 cycles of systemic therapy and at completion of therapy.
对于仅接受全身性治疗或放疗后序贯全身治疗的患者,应在每2周期全身治疗后以及治疗结束时行胸部//肾上腺强化CT评估疗效。

* Extensive-stage
*
广泛期

During systemic therapy, response assessment by CT chest/liver/adrenal with contrast should occur after every 2–3 cycles of systemic therapy and at completion of therapy.
在全身治疗期间,在每2–3周期全身治疗后以及治疗结束时应该进行胸部//肾上腺强化CT评估疗效。

For patients with asymptomatic brain metastases receiving systemic therapy before whole-brain RT, brain MRI (preferred) or CT with contrast should be repeated after every 2 cycles of systemic therapy and at completion of therapy.
对于在全脑放疗前接受全身治疗的无症状脑转移患者,在每2周系统治疗后以及治疗结束后应该复查脑MRI(首选)或强化CT

* Subsequent systemic therapy
*后续全身治疗

Response assessment by CT chest/liver/adrenal with contrast should occur after every 2–3 cycles of systemic therapy.
在每2–3周期全身治疗后应该进行胸部//肾上腺强化CT评估疗效。


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发表于:2016-10-06 08:59

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