Small cell lung cancer: features, treatment, life expectancy. What is small cell lung cancer Central small cell lung cancer

The disease, expressed by strong tumor growth and an increase in malignant cells in the lungs of a person, as a rule, implies stage 4 lung cancer and, unfortunately, the prognosis for it is unfavorable. With grade 4 cancer, extensive metastases are formed that grow beyond the lung, affect the lymph nodes, enter the liver, bone tissue, kidneys, and the human brain. As a result of this, the bronchial walls are affected, the mucous membrane and blood vessels are destroyed, more and more often pains appear in the chest. The pain that occurs in such cases is very closely related to the damage to the tissues adjacent to the lungs - oddly enough, the lung tissue itself does not have pain receptors.

The picture of the disease is very pronounced: paroxysmal, hysterical cough with the presence of blood secretions in the sputum. Shortness of breath, angina pectoris develops, heart rhythm is disturbed.

Prognosis for non-small cell cancer

There are several types of lung cancer, these include:

Non-small cell lung cancer - malignant tumors formed from the tissues of the epithelium. In 90% of affected men and 80% of women, the disease occurs due to smoking. There are currently 3 types of non-small cell cancer:

1. Squamous cell carcinoma is the most common, growing in the tissues of the respiratory tract.
2. Adenocarcinoma occurs in the tissues of the glands. Often found in people who do not smoke cigarettes and women.
3. Large cell (undifferentiated carcinoma) is called cancer due to the fact that cancer cells are clearly visible under a microscope. This disease can affect different parts of the body. One person out of ten gets sick.

Symptoms of the disease:

• cough;
• difficulty breathing, even without exertion;
• sputum with an admixture of bloody bodies;
• hoarseness;
• chest pain;
• lack of appetite, fatigue, the weight of a person decreases uncontrollably;
• violation of the swallowing reflex;
• swelling of the face of the body.

The prognosis for stage 4 non-small cell lung cancer is disappointing, since usually the disease already affects both lungs and metastasizes to other organs. 60% of cases are detected very late, the life span of patients for 5 years is no more than 17%. Squamous cell lung cancer arises from flat cells of the epithelium of the bronchi (which are not normally present).

As a rule, smokers and workers in hazardous industries get sick with cancer.

In addition, a number of other reasons affect the occurrence of squamous cell carcinoma:

1. Dust and gas pollution in the air in large cities.
2. Work in the radioactive zone.
3. Frequent diseases of pneumonia, bronchitis, tuberculosis.

The disease is most often detected in people 40-50 years of age, and men are more likely to get sick.

1. The reason for this is:
2. marginal lifestyle.
3. Poor quality food.
4. Lack of vitamins in food.
5. Heredity.

Signs of the disease:

1. Lethargy and lack of interest in life are often mistaken for another disease.
2. Unreasonable, instant weight loss.
3. Constant low temperature.

The prognosis for stage 4 squamous cell lung cancer is unfavorable - it is incurable, since metastases penetrate almost all internal organs and poisoning of the body begins. The organs necessary for human life do not cope with their functions and the person fades away.

Prognosis for small cell carcinoma

Small cell lung cancer stage 4 prognosis: life expectancy without therapy is from 6 to 18 weeks. This tumor is the aggressor. The focus spreads throughout the body with great speed. The characteristic signs of the disease are the same as in other types of cancer, with the addition of speech impairment and headache attacks.

Has two forms:

1. Small cell carcinoma is often an irreversible process that develops at lightning speed and attacks extensively.
2. Combined small cell carcinoma - includes a type of adenocarcinoma with signs of squamous cell and oat cell carcinoma.

(Moscow, 2003)

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

Small cell lung cancer (SCLC) is a peculiar form of lung cancer, which differs significantly 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 and radiation therapy compared to NSCLC.

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 radiological 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 the 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.

Recently, 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 damage to 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%.

A randomized study showed the advantage of surgery over radiation therapy as the first stage of complex treatment of 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 up to 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 case 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 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 (ER -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, a mandatory component of localized SCLC therapy.

Most of the new regimens of modern chemotherapy are built on the basis of either adding a new drug to the combination of EP (or EC), 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 a combination of 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 carried out 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.

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 are undergoing phase II-III clinical trials.

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 in SCLC of combinations of Taxol and doxorubicin, Taxol and platinum derivatives, Taxol with topotecan, gemcitabine and other drugs 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
Results of three therapeutic regimens including Taxol in SCLC. (Hainsworth, 2001) (30)

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)

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 (84% vs. 68% overall efficacy, median survival 12.8 vs. 9.4 months, 2-year survival 19% vs. 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 with unfavorable prognostic factors were included - a total of 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.

A fundamentally new group of anticancer drugs are molecularly targeted, the so-called targeted (target-target, goal), drugs with a 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 problems of a general nature are preliminary considered: intensification of doses of antitumor drugs, the feasibility of maintenance therapy, treatment of elderly patients and patients in a serious 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 also confirmed by a meta-analysis of materials from 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 were treated with high-dose consolidation chemotherapy with bone marrow transplantation and radiation. After such intensive therapy, 15 of 19 patients had complete tumor regression, and the two-year survival rate reached 53%. The method of late intensification is the subject of clinical research and has not yet gone beyond the limits of 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 case of severe general condition and 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.

The effectiveness of modern therapy in localized SCLC 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 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 receiving 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 specialists prefer the use of 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 carried out 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 effect of 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 completion. .

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), 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 chemo- and chemoradiotherapy followed by surgery continues to be studied, but there is no conclusive 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 tumor area of ​​the lung 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 recent years a whole group of new anticancer drugs active in SCLC has appeared allows us to hope for further improvement in therapeutic regimens and, accordingly, improvement in treatment outcomes.

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

In the WHO histological classification of lung tumors (1981), small cell carcinoma is represented by three variants: oat cell carcinoma, intermediate cell carcinoma, and combined oat cell carcinoma. The small-cell type accounts for 1-4% of all epithelial neoplasms of the trachea and is a highly malignant tumor consisting of small rather uniform cells with scanty cytoplasm and delicate chromatin diffusely distributed throughout the nucleus, sometimes hypertrophied nucleoli are detected.

As a rule, no signs of differentiation are detected in tumor cells during a light-optical examination, although in some cases, single or small groups of cells are found with signs of squamous epithelial or glandular differentiation during electron microscopy. This group of tumors is also characterized by the production of various hormones, such as ACTH, serotonin, antidiuretic hormone, calcitonin, growth hormone, melanocyte-stimulating hormone, and estrogen.

In recent years, it has been especially emphasized in the literature that the group of small cell carcinoma is heterogeneous and is represented by variants that differ in the nature of growth, antigenic composition, production of biomarkers, cytogenetic features, expression and amplification of oncogenes, and different sensitivity to antitumor therapy. The most common and characteristic biological sign is the production of 4 markers in cells, two of which are enzymes of the APUD system (L-DOPA-decarboxylase, neuron-specific enolase), the rest are the peptide hormone bombesin (gastrin-releasing peptide) and BB isoenzyme creatine kinase.

Small cell carcinoma is characterized by a pronounced tendency to metastasize already in the early stages of tumor development, a poor prognosis, and a short life expectancy of patients.

Thus, small cell tracheal cancer is characterized by the presence of the following main features: small cell size, absence of light-optical signs of differentiation, rapid growth, early and extensive metastasis, high sensitivity to specific therapy, the presence of specific biomarkers, and the production of various hormones. The first five features distinguish small cell carcinoma from hormone-producing non-small cell types of tracheal cancer and carcinoids.

Currently, there are two points of view regarding the histogenesis of small cell carcinoma of the respiratory tract.

According to the first hypothesis, small cell carcinoma develops from cells of the diffuse endocrine system (APUD system), which in the embryonic period migrate to the lungs from the neural crest.

The second hypothesis states that this group of tumors arises from cells of the bronchial lining, which are of endodermal origin and have the same morphological and biochemical features as small cell carcinoma cells.

Proponents of the first point of view substantiate their hypothesis by the fact that morphological structures (neuroendocrine granules ranging in size from 50 to 500 nm) are found in the elements of small cell respiratory tract cancer, as well as biochemical markers inherent in the cellular elements of the APUD system, the origin of which is associated with the neural crest. In humans, the presence of such cells in the bronchial glands, large bronchi and bronchioles has been proven. These data led to the widespread opinion that small cell carcinoma of the trachea belongs to tumors of the APUD system and is an extremely aggressive type of malignant carcinoid. At the same time, it is postulated that neuroendocrine differentiation is inherent only in cells that are derivatives of the neural crest.

Proponents of the second hypothesis believe that small cell carcinoma of the trachea, like other histological types, develops from cells of endodermal origin. This hypothesis is confirmed by the presence in the elements of small cell respiratory tract cancer of common features characteristic of all histological types, the difference between small cell carcinoma of the trachea and other neuroendocrine neoplasms. In addition, experimental data indicate that signs of neuroendocrine differentiation may also be inherent in cellular elements of endodermal origin.

In recent years, a number of experimental studies have shown that enterochromaffin cells of the gastrointestinal tract, islet cells of the pancreas, previously considered to be derivatives of the neuroectoderm, actually have an endodermal origin, which is common with other epithelial elements of these systems.

It is currently believed that the APUD cells of the gastrointestinal tract are not derived from the neural crest. So far, we do not have convincing data on the migration of neural crest cells into the trachea. At the same time, neuroendocrine granules are often found in mucus-producing cells of the normal bronchial lining. However, the possibility of migration of neuroectoderm elements into the trachea cannot be completely denied, since the development of such a tumor in the trachea as melanoma testifies in favor of this.

To the above facts, it should be added that small cell carcinoma of the trachea differs significantly from carcinoid (including its atypical variety) by etiological factors (smoking, radiation exposure, exposure to chloro-methyl-methyl ether). Often, in small cell carcinoma of the trachea, tumor elements with neuroendocrine differentiation are combined with non-endocrine malignant cells with signs of squamous epithelial or glandular differentiation (G. Saccomano et al., 1974). Such heterogeneity may indicate the presence of a single stem cell for all types of tracheal cancer (A. Gazdar et al., 1985).

At the same time, heterogeneity is not typical for tumors of the APUD system. Small cell airway cancer usually does not occur as a manifestation of multiple endocrine neoplasia syndrome. With regard to the morphological similarity of small cell tracheal cancer with other tumors of the APUD system, neuroendocrine granules are also detected in a small number of tumor cells of non-small cell airway cancer, the number of granules in small cell type cells is smaller and they are small in size. It is important to emphasize that the cellular elements of many tumors, clinically and morphologically regarded as small cell tracheal cancer, do not contain neurosecretory granules at all, but have well-developed desmosomes and tonofilaments, that is, in fact, they are poorly differentiated squamous cell forms of cancer (Mackay et al., 1977). In addition, it has been shown that the secretion of hormones is inherent not only in small cell, but also in other types of respiratory tract cancer.

Thus, there are currently no sufficiently convincing data indicating the priority of the first or second hypothesis. In this regard, small cell carcinoma of the trachea should be considered as a type of bronchogenic cancer originating from the bronchial epithelium, but having biochemical and ultrastructural features similar to tumors of the APUD system.

Cytological characterization. In the study of sputum, the most characteristic cytological sign of small cell carcinoma is the small size of tumor cells (about 1.5-2 times larger than a lymphocyte), located either in the form of massive clusters or in chains (“goosebumps”) along the strands of mucus (Fig. 18). In the bronchoscopic material, peculiar clusters of tumor cells are often found. Cell nuclei are round, oval, semi-lunar or irregularly triangular in shape with flattening or depressions on the adjacent surfaces of adjacent cells, designated as “facets” or “congruent areas”. This feature can be considered pathognomonic for small cell carcinoma.

It is important to note that the use of different stains (tissue or hematological) gives different staining results for nuclear chromatin. When stained according to the Papanicolaou method (or its modifications), the nuclei of elements of small cell carcinoma are hyperchromic with reticulated or coarse-grained chromatin. When stained by the Pappenheim method, the chromatin in the nuclei appears finely dispersed, the nuclei are pale, optically empty. It is this feature that makes it possible to reliably distinguish this tumor from poorly differentiated squamous cell carcinoma. The rim of the cytoplasm is very narrow, in most tumor cells it is practically not detected. Particular difficulties arise in the differential diagnosis of this form of cancer with the lymphoblastic variant of lymphosarcoma in cases where there is a metastatic lesion of the mediastinal lymph nodes without a primary focus identified in the trachea.

Another variant of small cell carcinoma is intermediate cell type cancer. We diagnose this variant when the material is represented by anaplastic tumor cells, the nuclei of which are approximately equal in size to the nuclei of oat cell carcinoma, but the chromatin is more compact, granular or stranded, and the rim of the cytoplasm is rather wide. In the cells of this tumor, as a rule, a large number of pathological mitoses, which distinguishes it from poorly differentiated squamous cell carcinoma. It should be emphasized that in metastatically affected lymph nodes of the mediastinum in oat cell carcinoma, areas of cancer are often found, consisting exclusively of cells of an intermediate type.

The cytological characterization of combined oat cell carcinoma is based on the simultaneous presence of features characteristic of oat cell carcinoma and squamous cell carcinoma or adenocarcinoma.

Histological characteristics. Oat cell carcinoma consists of rather monomorphic, small-sized cells of a round, polygonal or elongated shape (Fig. 19). However, there may be mild polymorphism in cell size and shape. As a rule, cells are twice as large as a lymphocyte, contain a centrally located nucleus with fine chromatin and inconsistent nucleoli. Individual cells have denser hyperchromic nuclei, especially in fields with degenerative and necrotic changes. The cytoplasm is sparse, usually basophilic. Despite rapid tumor growth, mitosis is rare.

Cellular elements are located, as a rule, friable, the stroma is scanty, there is no lymphocytic or other inflammatory infiltration, even in areas with necrotic changes. Usually the tumor grows in the form of wide strands, in some areas there is the presence of trabecular, alveolar structures or palisade-shaped cells around delicate blood vessels - pseudorosettes. Necrotic and degenerative changes in the tumor have a characteristic appearance: along the walls of blood vessels and other connective tissue structures, there is an accumulation of basophilic substance due to the deposition of nuclear material, which is not found in other types of cancer and carcinoids.

Intermediate cell cancer is represented by rather polymorphic tumor elements of a polygonal or spindle shape, larger than in classical small cell cancer, the cell size is three times larger than a lymphocyte. The nuclei of these cells contain a noticeable amount of clumps of chromatin and unstable nucleoli. Some cells have scant cytoplasm, while others have a more pronounced soft basophilic or light-optically transparent cytoplasm. In cells of this type, pronounced mitotic activity is noted.

In separate neoplasms, along with small cell carcinoma, areas can be detected where tumor elements have the structure of squamous or glandular cancer of various differentiation - combined oat cell carcinoma.

The greatest difficulties in the differential diagnosis of small cell tracheal cancer with other histological types arise when evaluating bronchobiopsy material, where tumor elements, due to their high sensitivity to mechanical stress, can be severely destroyed and resemble lymphocytic accumulations or inflammatory infiltration. Particular difficulties arise in the differential diagnosis of small cell tracheal cancer with atypical carcinoid and other poorly differentiated forms of cancer.

Most often, small cell carcinoma has to be differentiated from poorly differentiated squamous cell carcinoma, whose cells, as a rule, have abundant, well-defined cytoplasm. With the help of a green light filter, intercellular bridges can also be detected in some areas. The nuclei are more hyperchromic and the cytoplasm is eosinophilic, indicating epidermoid differentiation. In some cases, without the use of special research methods, the differential diagnosis of small cell tracheal cancer with other microscopically similar tumors is practically impossible.

Ultrastructure. Small rounded, oval or elongated cells are detected, lying separately or in small groups in the collagen fiber stroma (Fig. 19). Irregularly shaped nuclei with large clumps of chromatin. The cytoplasm is sparse with a small number of organelles (ribosomes, polysomes, small mitochondria, short SER profiles) and single rounded or polymorphic neurosecretory granules. Solitary neurosecretory granules may occur in non-small cell types of cancer, consisting predominantly of larger undifferentiated cells and elements with weak signs of glandular differentiation (microvilli). The cytoplasm in these cells is more abundant, contains ribosomes, polysomes, mitochondria, multiple profiles of the rough and smooth endoplasmic reticulum.

Small cell lung cancer is a malignant neoplasm that develops as a result of pathological changes in the cells of the mucous membrane of the 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:

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 of this disease. If metastasis is observed, in most cases it affects 90% of the 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 a common cold, because a person will experience a cough, hoarseness, and difficulty breathing. 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 the total number of 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. chest x-ray;
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 with other diagnostic procedures if necessary.

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 progresses very quickly, often being detected already at the stage of metastasis, doctors will use chemotherapy or radiation therapy as additional methods of treating SCLC. At the same time, irradiation or therapy with anticancer drugs can be carried out before surgery, with the aim 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 results. 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 either internal or external, depending on the size of the tumor and the extent 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.

Oncological pathologies are widespread throughout the world. The incidence of cancer is increasing every year. This is due to the fact that at present the methods of diagnosing oncological pathologies have improved significantly. One of the most common forms is small cell lung cancer. Millions of people die every year from this disease worldwide. The question of how long people live with lung cancer is very relevant. Doctors have been trying to find a cure for oncological pathologies for a long time. In modern times, oncologists have made great strides in this area. Such advances are mainly associated with early diagnosis of the disease. In addition, treatment methods are constantly being improved.

Types of small cell lung cancer

Like all lung cancer, there are varieties. The classification is based on the radiological forms and types of cells from which the tumor is formed. Depending on the morphology, 2 types of oncological processes are distinguished. More common It has a more favorable course. small cell is characterized by rapid metastasis. Occurs on rarer occasions. Also, this disease can occur in a localized (local) and widespread form.

Depending on where exactly the tumor is located, the following types are distinguished:

1. central cancer. It is characterized by the fact that the tumor is located in large and segmental bronchi. Most often, this pathology is difficult to diagnose.
2. peripheral cancer. The oncological process develops in the lung tissue itself.
3. Apical cancer. It also affects lung tissue. This variety is separated into a separate group, as it differs in the clinical picture (grows into the vessels of the shoulder girdle, neck).
4. Abdominal lung cancer.
5. Atypical and metastatic forms.
6. Pneumonia-like tumor.

What is small cell lung cancer?

This type of cancer occurs in 25% of cases. It is classified as an aggressive form due to its rapid spread to the lymphatic system. If oncological pathology is suspected in smokers, the diagnosis is often small cell lung cancer. Life expectancy in this disease primarily depends on the stage of the process. The individual characteristics of the organism and the tolerability of treatment also matter. The malignancy of this type of cancer is due to the fact that it arises from undifferentiated cells. Such a tumor seems to “seed” the lung parenchyma over a large extent, as a result of which it is difficult to detect the primary focus.

Etiology of small cell carcinoma

Like any oncological pathology, small cell lung cancer does not just happen. Atypical cells begin to multiply due to several predisposing factors. The main cause of small cell cancer is smoking. There is also a relationship between morbidity and exposure to harmful substances (heavy metals, arsenic). The likelihood of developing cancer is increased in older people who have a high smoker index (having used tobacco for many years). Predisposing factors include chronic lung diseases, including tuberculosis, COPD, obstructive bronchitis. The risk of developing small cell cancer is increased among people who have constant contact with dust particles. With a combination of factors such as smoking, chronic diseases and occupational hazards, the likelihood of a tumor is very high. In addition, the reasons for the development of oncological processes include a decrease in the body's immune defenses and chronic stress.

Stages of small cell lung cancer

The question of how long they live with lung cancer can only be answered by knowing the stage of the disease. It depends on the size of the oncological process and the degree of spread to other organs. Like most tumors, lung cancer has 4 stages. In addition, there is also the initial phase of the disease. In another way, it is called "precancer". This phase is characterized by the fact that small cell elements are located only on the inner lining of the lungs.

The first stage of cancer is characterized by a tumor size of up to 3 cm. At the same time, nearby lymph nodes are not damaged. Around the tumor process is healthy lung tissue.

Second stage. There is an increase in size (up to 7 cm). Lymph nodes remain intact. Nevertheless, the tumor grows into the pleura and bronchi.

Third stage. It is characterized by the large size of the oncological process. Cancer grows into the lymph nodes of the chest, vessels of the neck and mediastinum. Also, the tumor can spread to the tissue of the pericardium, trachea, esophagus.

The fourth stage is characterized by the appearance of metastases in other organs (liver, bones, brain).

Clinical picture of small cell lung cancer

Clinical manifestations of the disease depend on the stage of small cell lung cancer. At the initial stages, the pathology is very difficult to diagnose, since there are practically no symptoms. The first signs of cancer are observed in the second stage of the disease. These include: increased shortness of breath, a change in the nature of cough (in patients with COPD), chest pain. In some cases, the appearance of blood in the sputum is noted. The changes that occur in the third stage depend on where the tumor has grown. When the heart is involved in the process, symptoms such as pain, arrhythmias, tachycardia or bradycardia appear. If the tumor affects the pharynx and esophagus, there is a violation of swallowing, choking. The terminal stage is characterized by general weakness, enlarged lymph nodes, subfebrile temperature and weight loss.

Small cell lung cancer: life expectancy with such a diagnosis

Unfortunately, this disease progresses very quickly. The life expectancy of patients depends on when exactly the terrible diagnosis was made - "small cell lung cancer". The prognosis of the disease is unfavorable. This is especially true for patients with stages 3 and 4 of the oncological process. In the initial forms, small cell carcinoma is also difficult to treat. Nevertheless, sometimes it is possible to achieve a delay in tumor growth. It is impossible to determine with accuracy how much time the patient has left to live. It depends on the human body and on the rate of cancer development. The five-year survival rate for small cell lung tumors is 5-10%.

Cancer Center (Moscow): cancer treatment

If the stage of the disease allows, then the cancer must be treated. Removal of the tumor and therapy will help not only prolong the life of the patient, but also alleviate his suffering. For effective treatment, you should find a qualified specialist and a good oncology center. Moscow is considered one of the cities where medicine is developed at a very high level. In particular, this applies to oncology. New methods of treatment are being developed here, clinical trials are being conducted. There are several regional oncological dispensaries and hospitals in Moscow. The most significant centers are also Blokhin. These oncology dispensaries have the latest treatment equipment and the best specialists in the country. Scientific experience is widely used abroad.

Small cell lung cancer: treatment

Treatment of small cell lung cancer is carried out depending on the nature of growth, size and stage of the tumor process. The main method is chemotherapy. It allows you to slow down the growth of the tumor, increasing the life expectancy of the patient for months and years. Chemotherapy can be used at all stages of the oncological process, with the exception of the terminal phase. In this case, the patient's condition should be relatively satisfactory and not be accompanied by other severe pathologies. Small cell lung cancer may have a localized form. In this case, chemotherapy is combined with surgical treatment and radiation therapy.