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Cancer de Plaman Cu Celule Mici
Cancer de Plaman Cu Celule Mici
Palak Desai, MD
Natural History of SCLC
SCLC is distinguished from NSCLC by its rapid
doubling time, high growth fraction, and the
early development of widespread metastases
Although considered highly responsive to
chemotherapy and radiotherapy, SCLC usually
relapses within two years despite treatment
Overall, only three to eight percent of all
patients with SCLC (10 to 13 percent of those
with limited disease) survive beyond five years
SCLC Histology
SCLC is a “small blue round cell tumor” from neuroendocrine cells
Classifications:
oat cell (lymphocyte-like), fusiform, polygonal
OR classical, large cell neuroendocrine, combined SCLC/NSCLC
Immunohisto tests:
TTF1+ (adeno & SCLC)
Keratin, epithelial membrane
Antigen
Cough 75%
Hemoptysis in 50%
Clubbing 16 to 29%
Hypercalcemia
Peripheral Neuropathy
SCLC Staging
SCLC Staging
SCLC Staging
Where does SCLC metastasize to?
Brain (30%)
Adrenal (20-40%)
Liver (25%)
Lung
Skeleton (35%)
Prognostic Factors
The host factors of poor performance status and weight loss
Stage (limited versus extensive).
In extensive disease, the number of organ sites involved is
inversely related to prognosis
Metastatic involvement of the central nervous system, the
marrow, or the liver is unfavorable compared to other sites,
although these variables are confounded by the number of
sites of involvement.
In most trials, women fare better than men, although the
reasons for this are not known.
The presence of paraneoplastic syndromes is generally
unfavorable
Survival
Limited Stage:
Median OS: 14-24 months
5-yr OS: 20%
Extensive Stage:
MedianOS: 6-11 months
5-yr OS: 2%
Workup
Limited vs. Extensive stage
Limited stage Extensive stage
NO difference in
outcomes/survival
Pignon et a, 1992
Meta-analysis comparing
chemotherapy alone with
chemotherapy combined with
thoracic radiotherapy
13 trials and 2140 patients with
limited disease
If patients relapse more than 6 months after first line treatment, then
treatment with their original regimen is recommended
Topotecan
Topotecan and cyclophosphamide, doxorubicin, and vincristine (CAV)
were evaluated in a randomized, multicenter study of patients with
small-cell lung cancer (SCLC) who had relapsed at least 60 days after
completion of first-line therapy.
Patients received either
topotecan (1.5 mg/m2) as a 30-minute infusion daily for 5 days every 21
days (n = 107)
CAV (cyclophosphamide 1,000 mg/m2, doxorubicin 45 mg/m2, and
vincristine 2 mg) infused on day 1 every 21 days (n = 104).
Median survival was 25.0 weeks for topotecan and 24.7 weeks for CAV (P = .795).