一例广泛期小细胞肺癌的循证治疗

Evidence-based Treatment of a Patient with Extensive Small Cell Lung Cancer

目的针对一例广泛期小细胞肺癌合并恶性胸水、肝转移的治疗问题,检索当前最佳临床证据,为患者恶性胸水的对症治疗和后续化疗方案提供依据。方法根据循证临床实践的PICO原则,提出问题,检索证据,对所获证据进行质量评价,并结合患者意愿制定治疗方案。结果共纳入10个随机对照试验,13个系统评价/Meta分析和3篇临床指南。证据结果表明:化疗能提高广泛期小细胞肺癌患者的生存率,艾迪注射液可以减轻放化疗所致的不良反应,提高患者的生存质量。EP方案是小细胞肺癌化疗最主要的标准化疗方案。结合患者情况,我们采用胸腔闭式引流术加经胸膜腔内注入博来霉素,待患者病情好转后,采用EP方案化疗,患者生存期要比广泛期小细胞肺癌的平均存活期长,生活质量得以提高,家属对治疗满意。结论广泛期小细胞肺癌患者以化疗为主,同时辅以对症、支持治疗,预防性头颅照射(PCI)可以减少脑转移的发生并提高患者生存率。

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.