Chemotherapy for small cell lung cancer treatment duration. Chemotherapy for cancer: how the procedure is performed and how long the course of treatment lasts. Treatment methods used

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PRACTICAL ONCOLOGY. T.6, No. 4 - 2005

GU RONC im. N.N.Blokhin RAMS, Moscow

M.B. Bychkov, E.N. Dgebuadze, S.A. Bolshakova

Research into new therapies for SCLC is currently underway. On the one hand, new regimens and combinations with lower levels of toxicity and greater efficiency are being developed, on the other hand, new drugs are being studied. The main goal of the ongoing research is to increase patient survival and reduce the frequency of relapses. It is necessary to continue studying the effectiveness of new drugs with a new mechanism of action.

Lung cancer is one of the most common cancers in the world. Non-small cell (NSCLC) and small cell (SCLC) forms of lung cancer occur in 80-85% and 10-15% of cases, respectively. As a rule, its small cell form is most often found in smokers and very rarely in non-smoking patients.

SCLC is one of the most malignant tumors and is characterized by a short history, rapid course, and has a tendency to metastasize early. Small cell lung cancer is a tumor that is highly sensitive to chemotherapy, and an objective response can be obtained in most patients. When complete tumor regression is achieved, prophylactic irradiation of the brain is performed, which reduces the risk of distant metastasis and increases overall survival.

When diagnosing SCLC special meaning has an assessment of the prevalence of the process, which determines the choice of therapeutic tactics. After morphological confirmation of the diagnosis (bronchoscopy with biopsy, transthoracic puncture, biopsy of metastatic nodes), computed tomography (CT) of the chest is performed and abdominal cavity, as well as CT or magnetic resonance imaging (MRI) of the brain (with contrast) and bone scan.

Recently, there have been reports that positron emission tomography can further clarify the stage of the process.

With SCLC, as with other forms of lung cancer, staging is used according to the international TNM system, however, the majority of patients with SCLC already have stages III-IV of the disease at the time of diagnosis; therefore, the classification according to which distinguishes between localized and widespread forms of the disease.

In the localized stage of SCLC, the tumor lesion is limited to one hemithorax with the involvement of the regional ipsilateral lymph nodes of the root and mediastinum, as well as the ipsilateral supraclavicular lymph nodes, when it is technically possible to perform irradiation using a single field.

A common stage of the disease is considered to be a process when the tumor lesion is not limited to one hemithorax, with the presence of contralateral lymphatic metastases or tumor pleurisy.

The stage of the process, which determines therapeutic options, is the main prognostic factor in SCLC.

Prognostic factors:

1. Degree of prevalence of the process: in patients with a localized process (not beyond chest) better results are achieved with chemoradiotherapy.

2. Achieving complete regression of the primary tumor and metastases: there is a significant increase in life expectancy and there is the possibility of complete recovery.

3. General condition of the patient: patients who begin treatment in good condition have a higher treatment efficiency and longer survival than patients in serious condition, debilitated, with severe symptoms of the disease, hematological and biochemical changes.

Surgical treatment is indicated only when early stages MRL ( T 1-2 N 0—1). It should be supplemented with postoperative chemotherapy (4 courses). In this group of patients 5 -year survival rate is 39 % [ 33 ].

Radiation therapy leads to tumor regression in 60-80% of patients, but alone it does not increase life expectancy due to the appearance of distant metastases [ 9 ].

Chemotherapy is the cornerstone of treatment for SCLC. Among the active drugs it should be noted: cyclophosphamide, doxorubicin, vincristine, etoposide, topotecan, irinotecan, paclitaxel, docetaxel, gemcitabine, vinorelbine. Their effectiveness in monotherapy ranges from 25 to 50%. In table 1 shows the schemes of modern combination chemotherapy for SCLC.

Efficiency modern therapy of this form of SCLC ranges from 65% to 90%, with complete tumor regression in 45-75% of patients and a median survival of 1824 months. Patients who start treatment in good general condition (PS 0-1) and respond to induction therapy have a chance of 5-year disease-free survival.

For a localized form of SCLC, chemotherapy (CT) is performed according to one of the above regimens (2-4 courses) in combination with radiation therapy (RT) to the area of ​​the primary lesion, lung root and mediastinum with a total focal dose of 30-45 Gy (50-60 Gr by isoeffect). The start of radiation therapy should be as close as possible to the start of chemotherapy, i.e. It is best to start RT either against the background of 1-2 courses of chemotherapy, or after assessing the effectiveness of treatment of two courses of chemotherapy.

Patients who have achieved complete remission are recommended to undergo prophylactic irradiation of the brain with a total dose of 30 Gy due to high risk(up to 70%) metastasis to the brain.

The median survival of patients with localized SCLC using combination treatment is 16-24 months, with a 2-year survival rate of 40-50%, and a 5-year survival rate of 10%. In the group of patients who began treatment in good general condition, the possibility of achieving 5-year survival is 25%.

In such patients, the main treatment method is combination chemotherapy in the same regimens, and radiation 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 with complete tumor regression is significantly higher than with partial regression, and approaches the survival rate of patients with localized SCLC.

Table No. 1.

Schemes of modern combination chemotherapy for SCLC

For metastatic lesions of the bone marrow, distant lymph nodes, and metastatic pleurisy, the main method of treatment is chemotherapy. For metastatic lesions of the mediastinal lymph nodes with compression syndrome of the superior vena cava, it is advisable to use combined treatment (chemotherapy in combination with radiation). For metastatic lesions of the bones, brain, and adrenal glands, radiation therapy is the method of choice. With metastases to the brain radiation therapy in a total focal dose (SOD) of 30 Gy allows to obtain clinical effect in 70% of patients, and in half of them, complete regression of the tumor is recorded according to CT data. Recently, reports have appeared about the possibility of using systemic chemotherapy for brain metastases. In table 2 presents modern treatment tactics various forms MRL.

Despite the high sensitivity to chemotherapy and radiation therapy for SCLC, this disease has a high rate of relapses; in this case, the choice of drugs for second-line chemotherapy depends on the level of response to the first line of treatment, the duration of the relapse-free interval and the location of metastatic foci.

It is customary to distinguish between patients with sensitive relapse of SCLC, i.e. who had a history of complete or partial response to first-line chemotherapy and progression in at least 3 months after completion of induction chemotherapy. In this case, it is possible to reuse the treatment regimen against which the effect was detected. There are patients with refractory relapse, i.e. when disease progression is observed during the first line of chemotherapy or in less than 3 months after its completion. The prognosis of the disease in patients with SCLC is especially unfavorable for patients with refractory relapse - in this case, the median survival after diagnosis of relapse does not exceed 3-4 months. In the presence of a refractory relapse, it is advisable to use previously unused cytostatics and/or their combinations.

Recently, new drugs have been studied and already used in the treatment of SCLC, these include gemcitabine, topotecan, vinorelbine, irinotecan, taxanes, as well as targeted drugs.

Gemcitabine. Gemcitabine is an analogue of deoxytidine and belongs to the pyrimidine antimetabolites. According to research by Y. Cornier et al., its effectiveness in monotherapy was 27%, according to the results of a Danish study, the overall effectiveness level is 13%. Therefore, combination chemotherapy regimens including gemcitabine began to be studied. In an Italian study, treatment was carried out using the PEG regimen (gemcitabine, cisplatin, etoposide), with an objective efficacy rate of 72%, but high toxicity was noted. The London Lung Group published data from a randomized phase III trial directly comparing two treatment regimens: GC (gemcitabine + cisplatin) and PE. No differences in median survival were obtained, also noted here high level toxicity of the GC regimen.

Topotecan. Topotecan is a water-soluble drug that is a semi-synthetic analogue of camptothecin; it does not have cross-toxicity with other cytostatics used in the treatment of SCLC. The results of some studies indicate its effectiveness in the presence of resistant forms of the disease. Also, these studies revealed good tolerability of topotecan, characterized by controlled non-cumulative myelosuppression, a low level of non-hematological toxicity and a significant reduction clinical manifestations diseases. The use of topotecan in second-line treatment of SCLC is approved in approximately 40 countries, including the USA and Switzerland.

Vinorelbine. Vinorelbine is a semi-synthetic vinca alkaloid that is involved in preventing the depolymerization of tubulin. According to some studies, the response rate with vinorelbine monotherapy is 17%. It was also found that the combination of vinorelbine and gemcitabine is quite effective and has a low level of toxicity. In the work of J.D. Hainsworth et al. the partial regression rate was 28%. Several research groups have evaluated the efficacy and toxic profile of the combination of carboplatin and vinorelbine. The data obtained indicate that this regimen actively works in small cell lung cancer, however, its toxicity is quite high, and therefore it is necessary to determine the optimal doses for the above combination.

Table No. 2.

Modern tactics of treatment of SCLC

Irinotecan. Based on the results of a phase II study Japan Clinical Oncology Group started a randomized phase III trial JCOG -9511 for a direct comparison of two chemotherapy regimens: cisplatin + irinotecan ( P.I. ) and cisplatin + etoposide (PE) in previously untreated patients with SCLC. In the first combination, the dose of irinotecan was 60 mg/m2 in 1, 8 1st and 15th days, cisplatin - 60 mg/m2 on day 1 every 4 weeks, in the second combination cisplatin was administered at a dose of 80 mg/m 2 , etoposide - 100 mg/m 2 on days 1-3, every 3 weeks. In total, in the first and second groups, 4 course of chemotherapy. It was planned to include 230 patients in the work, however, recruitment was stopped after a preliminary analysis of the results obtained ( n =154), since a significant increase in survival rate was detected in the group receiving treatment according to the regimen P.I. (median survival rate is 12.8 vs 9.4 months, respectively). However, it should be noted that only 29% of patients randomized to the P.I. , were able to receive the required dose of drugs. According to this study, the pattern P.I. has been recognized in Japan as the standard of care for the treatment of localized SCLC. Due to the small number of patients, the data from this work needed to be confirmed.

Therefore, a study was launched in North America III phases Taking into account the already available results, the doses of the drugs were reduced. In the scheme P.I. the dose of cisplatin was 30 mg/m 2 in 1 th day, irinotecan- 65 mg/m2 in 1st and 8th th days of a 3-week cycle. Regarding toxicity, grade IV diarrhea has not been reported, and preliminary efficacy data are awaited.

Taxanes. In the work of J. E. Smyth et al. the effectiveness of docetaxel was studied 100 mg/m2 in monotherapy in previously treated patients ( n =28), objective effectiveness was 25% [ 32 ].

In the ECOG study included 36 previously untreated patients with SCLC who received paclitaxel 250 mg/m 2 as a 24-hour infusion every 3 weeks. At the same time, the level of partial regression was 30%, at 56 In % of cases, grade IV leukopenia was recorded. However, interest in this cytostatic did not wane, and therefore in the USA it was started Intergroup Study , where the combination of paclitaxel with etoposide and cisplatin (TER) or carboplatin (TEC) was studied. In the first group, chemotherapy was carried out according to the TEP regimen (paclitaxel 175 mg/m 2 in 1 day 1, etoposide 80 mg/m 2 in 1 - 3 days and cisplatin 80 mg/m 2 in 1 day, while the obligatory condition was the introduction of colony-stimulating factors from the 4th to the 14th days), in the RE regimen the drug doses were identical. A higher rate of toxicity was observed in the TEP group, unfortunately, no difference in median survival was obtained ( 10.4 versus 9.9 months).

M. Reck et al. presented data from a randomized trial III phase, in which the combination of TEC (paclitaxel 175 mg/m2) was studied in one group 2 on day 4, etoposide in 1 - 3 days at a dose of 125 mg/m 2 and 102.2 mg/m2 for patients with I - IIffi and stage IV disease, respectively, and carboplatin AUC 5 on the 4th day), in another group - CEV (vincristine 2 mg in the 1st and 8 days, etoposide from days 1 to 3 at a dose of 159 mg/m 2 and 125 mg/m2 patients with stage I-ShV and stage IV and carboplatin AUC 5 on the 1st day). The median overall survival was 12.7 versus 10.9 months, respectively, however, the differences obtained were not significant (p = 0.24). The level of toxic reactions was approximately the same in both groups. According to other studies, similar results were not obtained, so today taxane drugs are rarely used in the treatment of small cell lung cancer.

In SCLC therapy, new directions of drug treatment are being explored, tending to move from nonspecific medicines to the so-called targeted therapy aimed at specific genes, receptors, enzymes. In the coming years, it is the nature of molecular genetic disorders that will determine the choice of drug treatment regimens for patients with SCLC.

Targeted therapy for aHmu-CD56. Small cell lung cancer cells are known to express CD 56. It is expressed by peripheral nerve endings, neuroendocrine tissues, and myocardium. To suppress expression CD 56 conjugated monoclonal antibodies were obtained N 901-bR . Patients took part in phase I of the study ( n = 21 ) with relapsed SCLC, they received an infusion of the drug for 7 days. In one case, partial regression of the tumor was recorded, the duration of which was 3 months. In progress British Biotech (Phase I) studied monoclonal antibodies mAb , which are conjugated into a toxin DM 1.DM 1 inhibits the polymerization of tubulin and microtubules, leading to cell death. Research in this area is ongoing.

Thalidomide. There is an opinion that the growth of solid tumors depends on the processes of neoangiogenesis. Taking into account the role of neoangiogenesis in the growth and development of tumors, drugs are being developed aimed at stopping the processes of angiogenesis.

For example, thalidomide was known as an anti-insomnia drug, but was subsequently discontinued due to its teratogenic properties. Unfortunately, the mechanism of its antiangiogenic action is not known, however, thalidomide blocks vascularization processes induced by fibroblast growth factor and endothelial growth factor. In a phase II study, 26 patients with previously untreated SCLC underwent 6 courses of standard chemotherapy according to the PE regimen, and then for 2 years they received treatment with thalidomide(100 mg per day) with minimal toxicity. CR was registered in 2 patients, PR in 13, median survival was 10 months, 1-year survival was 42%. Taking into account the promising results obtained, it was decided to begin research III phases of the thalidomide study.

Matrix metalloproteinase inhibitors. Metalloproteinases are important enzymes involved in neoangiogenesis; their main role is participation in the processes of tissue remodeling and continued tumor growth. As it turned out, tumor invasion, as well as its metastasis, depend on the synthesis and release of these enzymes by tumor cells. Some metalloproteinase inhibitors have already been synthesized and tested for small cell lung cancer, such as marimastat ( British Biotech) and BAY 12-9566 (Bayer).

In a large study of marimastat, more than 500 patients with localized and disseminated forms of small cell lung cancer participated; after chemotherapy or chemoradiotherapy, one group of patients was prescribed marimastat (10 mg 2 times a day), the other was given placebo. It was not possible to achieve an increase in survival rate. In the work of studying BAY 12-9566 in the study group showed a decrease in survival, so studies of metalloproteinase inhibitors in SCLC were stopped.

Also, in SCLC, drugs were studied,receptor tyrosine kinase inhibitors (gefitinib, imatinib). Only in the study of imatinib (Gleevec) promising results were obtained, and therefore work in this direction continues.

Thus, in conclusion, it should be emphasized once again that research is currently underway on new therapies for SCLC. On the one hand, new regimens and combinations with lower levels of toxicity and greater efficiency are being developed, on the other hand, new drugs are being studied. The main goal of the ongoing research is to increase patient survival and reduce the frequency of relapses. It is necessary to continue studying the effectiveness of new drugs with a new mechanism of action. This review presents the results of some studies that include evidence from chemotherapy and targeted therapy. Targeted drugs have a new mechanism of action, which gives reason to hope for the possibility of more successful treatment of a disease such as small cell lung cancer.

Literature

1. Bychkov M.B. Small cell lung cancer. Guide to chemotherapy of tumor diseases / Ed. N.I. Translator. - M., 2005. - P. 203-208.

2. Anzai H., Frost P., Abbuzzese J.L. Synergistic cytotoxicity with combined inhibition of topoisomerase (Topo) I and II // Proc. Amer. Assoc. Cancer. Res. - 1992. - Vol. 33. - P. 431.

3. Ardizzoni A., Hansen H., Dombernowsky P. et al. Topotecan, a new active drug in the second-line treatment of small-cell lung cancer: a phase II study in patients with refractory and sensitive disease. The European Organization of Research and Treatment of Cancer Early Clinical Studies Group and New Drug Development Office, and the Lung Cancer Cooperative Group // J. Clin. Oncol. - 1997. - Vol. 15. - P. 2090-2096.

4. Auperin A., Arriagada R., Pignon JP. et al. Prophylactic cranial irradiation for patients with non-small cell lung cancer in complete remission. Preventive Cranial Irradiation Collaborative Group // New Engl. J. Med. - 1999. - Vol. 341. - P. 476-484.

5. Bauer K.S., Dixon S.C., Figg W.D. et al. Inhibition of angiogenesis by thalidomide requires metabolic activation, which is species0dependent // Biochem. Pharmacol. - 1998. - Vol. 55. - P. 1827-1834.

6. Bleehen NM, Girling DJ, Machin D. et al. A randomized trial of three or six courses of etoposide cyclophosphamide methotrexate and vincristine or six courses of etoposide and ifosfamide in small cell lung cancer (SCLC). I: survival and prognostic factors. Medical Research Council Lung Cancer Working Party // Brit. J. Cancer. - 1993. - Vol. 68. - P. 1150-1156.

7. Bleehen N.M., Girling D.J., Machin D. et al. A randomized trial of three or six courses of etoposide cyclophosphamide methotrexate and vincristine or six courses of etoposide and ifosfamide in small cell lung cancer (SCLC). II: quality of life. Medical research Council Lung Cancer Working Party // Brit. J. Cancer. - 1993. - Vol. 68. - P. 1157-1166.

8. Cormier Y, EisenhauerE, MuldalA et al. Gemcitabine is an active new agent in previously untreated extensive small cell lung cancer (SCLC). A study of National Cancer Institute of Canada Clinical Trials Group // Ann. Oncol. - 1994. - Vol. 5. - P. 283-285.

9. Cullen M, Morgan D, Gregory W. et al. Maintenance chemotherapy for anaplastic small cell carcinoma of the bronchus: a randomized, controlled trial // Cancer Chemother. Pharmacol. - 1986. - Vol. 17. - P. 157-160.

10. De Marinis F, Migliorino MR, Paoluzzi L. et al. Phase I/II trial of gemcitabine plus cisplatin and etoposide in patients with small-cell lung cancer // Lung Cancer. - 2003. - Vol. 39. - P- 331-338.

11. Depierrie A., von Pawel J., Hans K et al. Evaluation of topotecan (Hycamtin TM) in relapsed small cell lung cancer (SCLC). A multicentre phase II study // Lung Cancer. - 1997. - Vol. 18 (Suppl. 1). - P. 35.

12. Dowlati A, Levitan N., Gordon NH. et al. Phase II and pharmacokinetic/pharmacodynamic trial of sequential topoisomerase I and II inhibition with topotecan and etoposide in advanced non-small-cell lung cancer // Cancer Chemother. Pharmacol. - 2001. - Vol. 47. - P. 141-148.

13. Eckardt J, Gralla R, Pallmer M.C. et al. Topotecan (T) as second-line therapy in patients with small cell lung cancer (SCLC): a phase II study // Ann. Oncol. - 1996. - Vol. 7 (Suppl. 5). - P. 107.

14. Ettinger DS, Finkelstein DM, Sarma RP. et al. Phase Ii study of paclitaxel in patients with extensive-disease small-cell lung cancer: an Eastern Cooperative Oncology Group study // J. Clin. Oncol. - 1995. - Vol. 13. - P. 1430-1435.

15. Evans WK, Shepherd Fa, Feld R et al. VP-16 and cisplatin as first-line therapy for small-cell lung cancer // J. Clin. Oncol. - 1985. - Vol. 3. - P. 1471-1477.

16. Furuse K., Kubota K., Kawahara M. et al. Phase II study of vinorelbine in heavily previously treated small cell lung cancer. Japan Lung Cancer Vinorelbine Group // Oncology. - 1996. - Vol. 53. - P. 169-172.

17. Gamou S, Hunts J, Harigai H et al. Molecular evidence for lack of epidermal growth factor receptor gene expression in small cell lung carcinoma cells // Cancer Res. - 1987. - Vol. 47. - P. 2668-2673.

18. Gridelli C., Rossi A., Barletta E. et al. Carboplatin plus vinorelbine plus G-CSF in elderly patients with extensive-stage small-cell lung cancer: a poorly tolerated regimen. Results of a multicenter phase II study // Lung Cancer. - 2002. - Vol. 36. - P. 327-332.

19. Hainsworth JD, Burris III HA, Erland JB. et al. Combination chemotherapy with gemcitabine and vinorelbine in the treatment of patients with relapsed or refractory small cell lung cancer: a phase II trial of the Minnie Pearl Cancer Research Network // Cancer. Invest. - 2003. - Vol. 21. - P. 193-199.

20. James L.E., Rudd R., Gower N. et al. A phase III randomized comparison of gemcitabine/carboplatin (GC) with cisplatin/etoposide (PE) in patients with poor prognosis small cell lung cancer (SCLC) // Proc. Amer. Clin. Oncol. - 2002. - Vol. 21. - Abstr. 1170.

21. Jassem J., Karnicka-Mlodkowska H., van Pottelsberghe C. et al. Phase II study of vinorelbine (Navelbine) in previously treated small cell lung cancer patients. EORTC Lung Cancer Cooperative Group // Europ. J. Cancer. - 1993. - Vol. 29A. - P. 1720-1722.

22. Lee SM., James LE, Mohmmaed-Ali V. et al. A phase II study of carboplatin/etoposide with thalidomide in small cell lung cancer (SCLC) // Proc. Amer. Soc. Clin. Oncol. - 2002. - Vol. 21. - Abstr. 1251.

23. Lowebraun S., BartolucciA., Smalley RV. et al. The superiority of combination chemotherapy over single agent chemotherapy in small cell lung cancinoma // Cancer. - 1979. - Vol. 44. - P. 406-413.

24. Mackay HJ, O'Brien M, Hill S. et al. A phase II study of carboplatin and vinorelbine in patients with poor prognosis small cell lung cancer // Clin. Oncol. - (R. Coll. Radiol.). - 2003. - Vol. 15. - P. 181-185.

25. Moolenaar CE, Muller EJ., Schol DJ. et al. Expression of neural cell adhesion molecule-related sialoglycoprotein in small cell lung cancer and neuroblastoma cell lines H69 and CHP-212 // Cancer. Res. - 1990. - Vol. 50. - P. 1102-1106.

26. Niell H.B., Herndon J.E., Miller A.A. et al. Final report of a randomized phase III Intergroup trial of etoposide (VP-16) and cisplatin (DDP) with or without paclitaxel (TAX) and G-CSP in patients with extensive stage small cell lung cancer (ED-SCLC) // Lung Cancer . - 2003. - Vol. 41 (Suppl. 2). - S. 81.

27. Noda K., Nishiwaki Y., Kawahara M. et al. Irinitecan plus cisplatin compared with etiposide plus cisplatin for extensive small-cell lung cancer // New Engl. J. Med. - 2003. - Vol. 346. - P. 85-91.

28. Reck M, von Pawel J., Macha HN. et al. Randomized phase III trial of paclitaxel etoposide, and carboplatin versus carboplatin, and vincristine in patients with small-cell lung cancer // J. Natl. Cancer. Inst. - 2003. - Vol. 95. - P. 1118-1127.

29. Rinaldi D., Lorman N., Brierre J. et al. A phase I-II trial of topotecan and gemcitabine in patients with previously treated, advanced non-small cell lung cancer (LOA-3) // Cancer. Invest. - 2001. - Vol. 19. - P 467-474.

30. Rinaldi D., Lorman N., Brierre J. et al. A phase II trial of topotecan and gemcitabine in patients with previously treated, advanced nonsmall cell lung carcinoma // Cancer. - 2002. - Vol. 95. - P. 1274-1278.

31. Roy D.C., Ouellet S., Le Houillier et al. Elimination of neuroblastoma and small-cell lung cancer cells with an antineural cell adhesion molecule immunotoxin // J. Natl. Cancer. Inst. - 1996. - Vol. 88. - P. 1136-1145.

32. Sandler A, Langer C., BunnJrPA. et al. Interim safety analysis of irinotecan and cisplatin combination chemotherapy for previously untreated extensive small cell lung cancer // Proc. Amer. Soc. Clin. Oncol. - 2003. - Vol. 22. - Abstr. 2537.

33. Seifter EJ, Ihde D.C. Therapy of small cell lung cancer: a prospective on two decades of clinical research // Semin. Oncol. - 1988. - Vol. 15. - P. 278-299.

34. Shepherd FA, Giaccone G, Seymour L. et al. Prospective, randomized, double-blind, placebo-controlled trial of marim-astat after response to first-line chemotherapy in patients with small-cell lung cancer: a trial of national Cancer. Institute of Canada - Clinical Trials Group and European Organization for Research and Treatment of Cancer // J. Clin. Oncol. - 2002. - Vol. 20. - P. 4434-4439.

35. Smith I.E, Evans B.D. Carboplatin (JM8) as a single agent in combination in the treatment of small cell lung cancer // Cancer. Treat. Rev. - 1985. - Vol. 12 (Suppl. A). - P. 73-75.

36. Smyth JF, Smith IE, Sessa C. et al. Activity of docetaxel (Taxotere) in small cell lung cancer. The Early Clinical Trials Group of EORTC // Europ. J. Cancer. - 1994. - Vol. 30A. - P. 1058-1060.

37. Spiro S.G., Souhami R.L., Geddes D.M. et al. Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial // Brit. J. Cancer. - 1989. - Vol. 59. - P. 578-583.

38. Sundstrom S, Bremenes RM, Kaasa S et al. Cisplatin and etoposide regimen is superior to cyclophosphamide. Epirubicin, and vincristine regimen in small-cell lung cancer: results from randomized phase III trial with 5 year’follow-up // J. Clin. Oncol. - 2002. - Vol. 20. - P. 4665-4672.

39. von Pawel J., Depierre A., Hans K. et al. Topotecan (Hycamtin TM) in small cell lung cancer (SCLC) after failure of first line therapy: multicentre phase II study // Europ. J. Cancer. - 1997. - Vol. 33. (Suppl. 8). - P. S229.

40. von Pawel J, Schiller JH, Shepherd FA et al. Topotecan versus cyclophosphamide, doxorubicin, and vincristine for the treatment of recurrent small-cell lung cancer // J. Clin. Oncol. - 1999. - Vol. 17. - P. 658-667.

41. Wu A.H., Henderson B.E., Thomas D.C. et al. Secular trends in histologic types of lung cancer // J. Natl. Cancer. Inst. - 1986. - Vol. 77. - P. 53-56.

It is important to compare the benefits and harms of this treatment method.

About the disease

Lung cancer is the presence of a malignant formation in the epithelial tissues of the bronchus. The disease is often confused with organ metastases.

Cancer is classified according to its location:

• central - manifests itself early, affects the mucous part of the bronchus, causes pain syndrome, characterized by cough, shortness of breath, increased body temperature;
• peripheral - painless until the tumor grows into the bronchi, leading to internal bleeding;
• massive – combines central and peripheral cancer.

About the procedure

Chemotherapy involves destroying cancer cells using certain poisons and toxins. It was first described in 1946. At that time, embiquin was used as a toxin. The drug was created on the basis of mustard gas, a toxic volatile substance of the First World War. This is how cytostatics appeared.

During chemotherapy, toxins are administered by drip or in tablet form. It must be taken into account that cancer cells are constantly dividing. Therefore, therapy procedures are repeated based on the cell cycle.

Indications

For a malignant tumor in the lung, chemotherapy is carried out before and after surgery.

The specialist selects therapy based on the following factors:

• tumor size;
• growth rate;
• spread of metastases;
• involvement of adjacent lymph nodes;
• patient's age;
• stage of pathology;
• accompanying illnesses.

The doctor needs to consider the risk and complications that accompany therapy. Based on these factors, the specialist decides on chemotherapy. For inoperable lung cancer, chemotherapy becomes the only chance of survival.

Experts divide types of chemotherapy treatment, focusing on drugs and their combination. Treatment regimens are indicated in Latin letters.

It is easier for patients to categorize treatments by color:

• Red is the most toxic course. The name is associated with the use of antacyclins, which are colored red. Treatment leads to a decrease in the body's defenses against infections. This is due to a decrease in the number of neutrophils.
• White – includes the use of Taxotel and Taxol.
• Yellow – the substances used are colored yellow. The body tolerates them a little easier than red antacyclins.
• Blue - includes drugs called Mitomycin, Mitoxantrone.

For a complete impact on all cancer particles, apply different types chemotherapy. The specialist can combine them until he sees positive effect from treatment.

Peculiarities

Carrying out chemotherapy to stop a malignant process in the lung has its differences. First of all, they depend on the type of oncology of the bronchopulmonary system.

For squamous cell carcinoma

The pathology arises from metaplastic cells of the squamous epithelium of the bronchi, which by default do not exist in tissues. The process of degeneration of ciliated epithelium into squamous epithelium develops. Most often, the pathology occurs in men after 40 years of age.

Treatment involves systemic therapy:

• drugs Cisplatin, Bleomecin and others;
• radiation exposure;
• Taxol;
• gamma therapy.

For adenocarcinoma

The most common type of non-small cell cancer respiratory tract is adenocarcinoma. Therefore, treatment of pathology with chemotherapy is often carried out. The disease originates from particles of glandular epithelium, does not manifest itself in the early stages, and is characterized by slow development.

The main form of treatment is surgery, which is supplemented with chemotherapy to avoid relapse.

Drugs

Treatment of lung cancer with anticancer drugs can consist of two options:

1. destruction of cancer particles is carried out using one drug;
2. Several medications are used.

Each of the medications offered on the market has an individual mechanism of action on malignant particles. The effectiveness of medications also depends on the phase of the disease.

Alkylating agents

Drugs that act on malignant particles at the molecular level:

• Nitrosoureas are urea derivatives that have antitumor effects, for example Nitrulline;
• Cyclophosphamide - used together with other antitumor substances in the treatment of lung oncology;
• Embiquin - causes disruption of DNA stability and interferes with cell growth.

Antimetabolites

Medicinal substances that can block the life processes in mutated particles, which leads to their destruction.

The most effective drugs:

• 5-fluorouracil – changes the structure of RNA, suppresses the division of malignant particles;
• Cytarabine – has anti-leukemia activity;
• Methotrexate – suppresses cell division, inhibits the growth of malignant tumors.

Anthracyclines

Medicines that contain components that can have a negative effect on malignant particles:

• Rubomycin – has antibacterial and antitumor activity;
• Adriblastin is an antitumor antibiotic.

Vincalcaloids

Medicines are based on plants that prevent the division of pathogenic cells and destroy them:

Epipodophyllotoxins

Medicines that are synthesized similarly to the active substance from mandrake extract:

• Teniposide – antitumor agent, a semi-synthetic derivative of podophyllotoxin, which is isolated from the roots of Podophyllum thyroid;
• Etoposide is a semisynthetic analogue of podophyllotoxin.

This article contains recipes for treating lung cancer with soda.

Carrying out

Chemotherapy is administered intravenously. The dosage and regimen depend on the chosen treatment regimen. They are compiled individually for the individual patient.

After each therapeutic course, the patient’s body is given the opportunity to recover. The break can last 1-5 weeks. Then the course is repeated. Along with chemotherapy, accompanying maintenance treatment is carried out. It improves the patient's quality of life.

Before each course of treatment, the patient is examined. Based on blood results and other indicators, it is possible to adjust the further treatment regimen. For example, it is possible to reduce the dose or postpone the next course until the body recovers.

Additional methods of drug administration:

Harmful effects on the body

Antitumor treatment is accompanied by toxic reactions in 99% of cases. They do not serve as a reason to stop therapy. If life is at risk, the dose of the drug may be reduced.

The occurrence of toxic reactions is due to the fact that chemotherapy drugs kill active cells. These include not only cancer particles, but also healthy human cells.

• Nausea with vomiting - the medicine affects sensory receptors in the intestines, which in response to this release serotonin. The substance can excite nerve endings When the information reaches the brain, the vomiting process starts. You can influence the receptors with the help of antiemetic drugs. Nausea goes away after completing the course.

Stomatitis - medications kill epithelial cells of the oral mucosa. The patient's mouth becomes dry, cracks and wounds begin to form. They are painful to bear.

The oral cavity can be rinsed with a soda solution and with special wipes to remove plaque from the tongue and teeth. Stomatitis goes away as soon as the level of leukocytes in the blood increases after chemotherapy is completed.

Diarrhea - the effect of toxins on the epithelial cells of the colon and small intestine. Diarrhea caused by taking anticancer drugs is life-threatening for the patient, so the doctor may reduce the dosage or stop it altogether.

This worsens the prognosis for lung cancer. After carrying out the necessary tests, treatment for diarrhea begins. You can use herbs, Smecta, Attapulgite.

For advanced diarrhea, infusions of glucose, electrolyte solutions, vitamins, and antibiotics are prescribed. After treatment, the patient must adhere to a diet.

Irreversible consequences

The effects of chemotherapy in the treatment of lung cancer may take some time to appear. Eliminating them will take time and additional costs.

• Fertility – drugs cause a decrease in sperm levels in men and affect ovulation in women. This can lead to infertility. The only solution for young people is to freeze the cells until treatment is carried out.
• Osteoporosis – can occur up to a year after cancer treatment. The disease is caused by calcium loss. This leads to bone loss. It manifests itself as joint pain, brittle nails, leg cramps, and rapid heartbeat. Leads to bone fracture.
• A decline in immunity occurs due to a deficiency of leukocytes. Any infection can be life-threatening. It is necessary to carry out preventive measures in the form of wearing a gauze bandage, food processing. You can take a week-long Derinata course. It will take a lot of time to restore the body.
• Loss of strength – decrease in the number of red blood cells. A blood transfusion or the introduction of erythropoietin into the body may be required.
• The appearance of bruises, bumps - platelet deficiency leads to deterioration of blood clotting. The problem requires long-term treatment.
• Effect on the liver - the level of bilirubin in the blood increases. You can improve your liver condition with diet and medications.

What is the price

Some medications cannot be purchased on your own. They are issued only by prescription. Some medications can be found in regular pharmacies.

Lung cancer patients can receive medications for free. To do this, you need to contact an oncologist. The specialist must write a prescription. The list of free drugs is published on the Department of Health portal.

The patient with a prescription receives the medicine at the pharmacy, and brings the used ampoules and packaging to the oncologist for reporting. If the doctor does not want to write a prescription for a certain drug that is on the list of free drugs, you should write an application addressed to the head physician.

Free treatment and care for patients is provided in hospices, most of which are concentrated in Moscow and the region.

Forecast

During treatment, survival depends on the stage of development of the pathology and its form. The five-year survival rate after combination treatment is:

Chemotherapy increases the prognosis of survival after surgery by 5-10%. And at the last stage it is the only chance to prolong life.

In this video review, the patient talks about how he feels after chemotherapy for lung cancer:

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The use of chemotherapy for lung cancer: how to treat pathology with this method?

In the modern world, cancer is very common. More than eight million people die each year from lung cancer alone. To protect yourself and your loved ones, you need to monitor your health, get diagnosed periodically, and if a disease is detected, immediately contact a professional and treat it.

Lung cancer is malignant tumor which occurs in the lungs and bronchi. Most often, the disease progresses in the right lung and upper lobes. There can be either cancer of one lung or cancer of two lungs. The cells grow rapidly and can spread to other organs.

This disease is very dangerous and can be fatal. In terms of mortality, this disease ranks first among other cancers. Men who have crossed the sixty-year mark fall into the risk category. A common type is squamous cell lung cancer, in which the tumor grows through bronchial epithelial cells.

The disease has 4 stages (degrees):

• Stage 1 – a small tumor up to 2 cm in size that does not affect the lymph nodes;
• Stage 2 – mobile tumor more than 2cm, begins to affect lymphatic system;
• Stage 3 – tumor limited in movement. Characterized by metastatic lymph nodes;
• Stage 4 – extreme. The tumor grows and is localized in neighboring organs. Unfortunately, stage 4 cancer cannot be cured.

What stage a patient has can be determined after diagnosis.

The concept of chemotherapy and its scheme

Chemotherapy treatment refers to treatment with medications that stop the division and reproduction of cancer cells. There are other types of treatment, but they are not as effective.

Chemotherapy drugs are injected into the blood, where they directly perform their function and are distributed throughout the body. The main advantage of the treatment is that the drugs do not act on one specific area of ​​the body, but kill cancer cells wherever they are found, with virtually no effect on healthy organs.

The procedure is carried out at intervals of several weeks. This is necessary to restore immunity and rest the body. During the course, the doctor monitors the patient’s condition, collects tests, and conducts the necessary studies. All chemicals have a dosage that depends on the weight and age of the person.

• the medicine is injected into a vein using a thin needle;
• a catheter is installed, which is not removed until the end of the course;
• if possible, use the artery that is closest to the tumor;
• Preparations in the form of tablets and ointments are also used.

Chemotherapy squamous cell carcinoma lung disease involves the use of drugs that kill pathological cells.

The chemotherapy regimen must be effective and with minimal levels of side effects. All medications must be prescribed individually for the patient, and they must also be combined with each other.

Indications for chemotherapy for lung cancer

The procedure is prescribed depending on the disease, its stage, the patient’s age and other factors. The number of chemotherapy courses is prescribed directly by the doctor. First, they look at the size of the formation, its changes and deformations.

Pay attention to the general condition of the human body, the location of tumor formation and its progression. Chemotherapy for lung cancer helps stop the progression of the disease, and sometimes even get rid of it.

Ideally this therapy must completely destroy cancer cells. Subsequently, specialists prescribe chemotherapy drugs. The doctor prescribes all medications individually for each patient. Meet different types chemicals for lung cancer, which are selected and prescribed in the clinic.

Contraindications and side effects of chemotherapy for lung cancer

This method has a number of contraindications:

• deterioration of condition;
• disputes and doubts among doctors regarding the procedure;
• mental illness;
• infectious diseases;
• diseases (chronic) of the liver and kidneys;
• non-invasive cancer.

In addition, procedures may be canceled if:

• old age of the patient;
• immunodeficiency of the body;
• taking antibiotics;
• rheumatoid arthritis.

It is impossible to accurately predict the consequences. Some patients do not have them at all, while others experience a number of negative phenomena.

Medicine does not stand still and is trying to improve medications. But it is worth knowing about the negative consequences. They appear after the procedure, most often after a few days. The main ones include:

• nausea, vomiting, diarrhea, constipation and other disorders digestive tract;
• intestinal dysfunction. In turn, this leads to weight loss and a decrease in the body’s immune function, which is fraught with diseases;
• anemia;
• hair loss;
• bleeding and bruising;
• ulcers in the mouth.

In order to reduce side effects chemotherapy, the patient takes certain medications.

How to cope with side effects from chemotherapy?

Any chemistry affects the functioning of the body. Until now, they have not created a drug that would not be non-toxic and completely destroy cancer diseases. It is impossible to predict how difficult or easy a person will undergo the procedure.

The consequences of chemotherapy for lung cancer are varied: from hair loss to nausea and vomiting.

To alleviate the condition you need:

• take special medications that support the functioning of the kidneys, liver and bone tissue;
• worth keeping an eye on proper diet nutrition;
• reduce the amount of fatty, salty and spicy foods;
• spend more time in the fresh air;
• do not forget about walks and physical activity;
• communicate with the doctor, listen and adhere to all his recommendations;
• monitor your psychological state, have a positive mood, believe in a complete recovery and know that soon everything will pass and normal life will be restored.

Effect of use

Chemotherapy for lung cancer is effective. The disease is contained, cancer cells are destroyed, but the complete disappearance of oncology is most often impossible, since the cells have adapted to the medications.

A frequently asked question: “How long do you live after chemotherapy?” The exact number of years varies and depends on the individual case and the treatment received. After suffering from an illness, you can live quite a long time and lead a completely full life. Medicine knows happy cases of healing.

Treatment of lung cancer with chemotherapy has its positive results: due to the development of medicine, chemotherapy courses for lung cancer show better results every year and are carried out much less painfully than before. Therefore, this procedure needs to be done. You need to treat it with attention and understand that this is a necessary measure. And most importantly, you need to believe in a speedy recovery and never give up.

Proper nutrition during chemotherapy

During treatment, much depends on the patient himself. First of all, this concerns proper nutrition.

If side effects occur, a healthy, nutritious diet is essential. It helps the body function normally and the person to recover faster. Medicines negatively affect the digestive tract. A person faces a lot of difficulties. Therefore, further recovery also depends on the quality and regularity of nutrition.

You should drink a lot of water, at least one and a half to two liters a day during chemotherapy. It is very important to enrich your diet with all groups healthy products: proteins, grains, fruits and vegetables and dairy products. Protein products include: beans, fish, nuts, eggs, soy, meat. It is best to consume such foods at least once during the day. Dairy products include: kefir, yogurt, dairy products, cheese and others. They are rich in calcium and magnesium.

The diet should be enriched with fruits and vegetables, including dried fruits and compotes. This group of foods should be consumed at least four times a day. This is especially true when starting chemotherapy.

Drinking freshly squeezed juice will be beneficial. You should add fresh greens to your diet. Be sure to eat carrots and various fruits containing vitamin C. Also, do not forget about cereals and bread. They are rich in carbohydrates and B vitamins. You should eat porridge in the morning. During and after treatment in this way, you need to drink vitamins. Alcoholic drinks should be excluded.

Chemotherapy course

A course of chemotherapy is a tool for eliminating many types of malignant tumors. Its essence boils down to the use, during the treatment process, of medical chemicals that can significantly slow down the growth of defective cells or damage their structure.

Based on many years of research, doctors have developed their own doses of cytostatic drugs and application schedule for each type of tumor. The medications taken are strictly dosed and calculated depending on the patient’s body weight. The chemotherapy course protocol is prepared individually, for each patient separately.

In modern oncology, it has not yet been possible to obtain a drug that would meet two main categories in relation to the human body and cancer cells: low level toxicity to the body and effective effect on all types of tumor cells.

Who to contact?

How is the course of chemotherapy carried out?

Quite often, patients and their relatives have a natural question: “How is the chemotherapy course going?”

Based on the characteristics of the patient’s disease, the course of chemotherapy is carried out in a hospital or at home under the close supervision of an experienced oncologist with sufficient experience in such treatment.

If the attending physician allows therapy at home, then it is better to conduct the first session in a hospital setting, under the supervision of a doctor who, if necessary, will correct further treatment. When undergoing therapy at home, periodic visits to the doctor are mandatory.

Some ways to carry out a course of chemotherapy:

• Using a fairly fine injection needle, the medicine is injected into a vein in the arm (peripheral vein).
• A catheter, which is a small tube in diameter, is inserted into the subclavian or central vein. It is not removed during the course and the medicine is administered through it. Often the course takes several days. To control the volume of the administered drug, a special pump is used.
• If possible, they “connect” to the artery that passes directly through the tumor.
• Drugs in tablet form are taken orally.
• Intramuscular injections directly into the tumor site or subcutaneously.
• Antitumor medications, in the form of ointments or solutions, are applied directly to the skin at the site of tumor development.
• Medicines, if necessary, can be delivered to the abdominal or pleural cavity, into the spinal fluid or bladder.

Observations show that during the administration of anticancer drugs the patient feels quite well. Side effects appear immediately after completion of the procedure, after a few hours or days.

Duration of chemotherapy course

Treatment for each patient depends largely on the classification of the cancer; the goals pursued by the doctor; administered medications and the patient’s body’s reaction to them. The treatment protocol and duration of the chemotherapy course are determined individually for each patient by his doctor. The treatment schedule may consist of administering an anticancer drug every day, or staggered weekly doses, or the patient may receive chemical medications on a monthly basis. The dosage is precisely adjusted and recalculated depending on the body weight of the victim.

Patients receive chemotherapy in cycles (this is the time during which the patient receives anti-cancer drugs). The course of treatment most often ranges from one to five days. Next comes a break, which can last from one to four weeks (depending on the treatment protocol). The patient is given the opportunity to recover a little. After this, it goes through another cycle, which, in doses, continues to destroy or stop tumor cells. Most often, the number of cycles ranges from four to eight (as necessary), and the total treatment time usually reaches six months.

There are cases when the attending physician prescribes a repeat course of chemotherapy to the patient to prevent relapses; in this case, treatment can last for a year or a year and a half.

A very important element in the therapy process is strict adherence to dosages, timing of cycles, maintaining intervals between courses, even if, it would seem, there is no more strength. Otherwise, all the efforts made will not lead to the expected result. Only in exceptional cases, based on clinical tests, the doctor can temporarily stop taking cancer drugs. If a failure in the dosage schedule occurred due to the patient’s fault (forgot or for some reason was unable to take the necessary medication), you must inform your doctor about this. Only he can make the right decision.

With a long course of taking oncological drugs, partial or complete adaptation of cells may occur, so the oncologist conducts a test for sensitivity to this drug both before the start of treatment and during treatment.

Duration of chemotherapy course

Medicine and pharmacology do not stand still; new ones are constantly being developed innovative technologies and treatment regimens, more modern medicines are appearing. During the treatment process, oncologists prescribe oncological drugs or their most effective combinations. Moreover, depending on the patient’s diagnosis and the stage of its progression, the duration of the course of chemotherapy and its schedule are strictly regulated by international methods.

Cytostatic drugs, and complexes of them, are quantitatively composed according to the principle of minimal necessity to obtain the most significant effect on cancer cells while causing the least harm to human health.

The duration of the cycle and the number of courses are selected depending on the specific type of tumor, the clinical presentation of the disease, the drugs used in treatment, and the patient’s body’s response to the treatment (the doctor observes whether side deviations appear).

The therapeutic complex of measures can last on average from six months to two years. At the same time, the attending physician does not let the patient out of his field of vision, regularly undergoing the necessary tests (x-rays, blood tests, MRI, ultrasound and others).

Number of chemotherapy courses

In the terminology of medical oncologists there is such a thing as dose intensity. This name defines the concept of frequency and amount of medication administered to a patient over a certain period of time. The eighties of the twentieth century passed under the auspices of increasing dose intensity. The patient began to receive more medications, while the attending physician tried to avoid significant toxicity. But the patient and his family must understand that with a decrease in dose intake, for some types of cancer cells, the chances of recovery also decrease. In such patients, even with a positive result of treatment, relapses occur quite often.

Moreover, studies conducted by German scientists have shown that with the intensity of the dosage and the reduction of inter-course time, the treatment results are more impressive - the number of cured patients is much higher.

The number of chemotherapy courses largely depends on the patient’s tolerance medicines and stages of the disease. The oncologist in each specific case must take into account many different factors. One of the most important factors is the area of ​​localization of the disease, its type, the number of metastases and their prevalence. An important factor is the immediate condition of the patient. If the drugs are well tolerated, the tandem of the patient and the doctor goes through all the cycles of chemotherapy prescribed by the scheme, but if the doctor notices clear signs of toxicity in the patient (for example, a sharp drop in hemoglobin, leukocytes in the blood, exacerbation systemic diseases and others), the number of cycles is reduced.

In each specific case, the dosage regimen and the number of cycles are purely individual, but there are also generally accepted drug administration schedules, on which the treatment of many patients is based.

The most common treatment is the Mayo regimen. The patient takes fluorouracil with leucovorin at a dosage of 425 mg intravenously for one to five days with a four-week break. But the number of chemotherapy courses themselves is determined by the attending physician based on the stage of the disease. More often than not, six courses – about six months.

Or the Roswell Park scheme. Administration of cancer drugs once a week, every six weeks for a treatment course of eight months.

Long-term studies provide the following figures for the five-year survival rate of patients (for a specific type of lung cancer and the same stage of its development): three courses of chemotherapy are 5%, with five cycles - 25%, if the patient has completed seven courses - 80%. Conclusion: with fewer cycles performed, hope for survival tends to zero.

Is it possible to interrupt the course of chemotherapy?

When faced with this problem, patients almost always ask their doctor a logical question: is it possible to interrupt the course of chemotherapy? The answer here may be clear. Interrupting the course of treatment, especially in its later stages, is fraught with quite serious setbacks to the primary form of the disease, up to deaths. Therefore, it is unacceptable to stop taking prescribed anti-cancer drugs on your own. It is necessary to strictly adhere to the drug administration regimen itself. The attending physician should immediately know about any violation of the regime (due to forgetfulness, or due to some objective circumstances). Only he is able to advise something.

Interruption of the course of chemotherapy is possible only with the informed decision of the oncologist. He can make such a decision based on clinical indications and visual observation of the ward. The reasons for such an interruption may be:

• Exacerbation of chronic diseases.
• A sharp drop in the number of leukocytes in the blood.
• Reduction to critical hemoglobin.
• And others.

Break between chemotherapy courses

Most drugs taken during chemotherapy work to kill rapidly dividing cancer cells. But the division process for both cancer and normal cells proceeds the same way. Therefore, no matter how sad it may sound, the drugs taken expose both cells to the same effect human body, causing side effects. That is, healthy cells also become damaged.

So that the patient’s body can rest for at least some time, recover slightly and “start fighting the disease” with renewed vigor, oncologists necessarily introduce breaks between chemotherapy courses. Such a vacation can last about one to two weeks, in exceptional cases - up to four weeks. But based on monitoring carried out by German oncologists, the density of chemotherapy courses should be as high as possible, and the rest time as short as possible, so that during this period of time the cancerous tumor cannot grow again.

1 course of chemotherapy

During 1 course of chemotherapy, not all, but only a certain percentage of cancer cells are usually destroyed. Therefore, oncologists almost never stop at one treatment cycle. Based on general clinical picture The oncologist may prescribe from two to twelve cycles of chemotherapy.

Taken together, the time the patient receives anticancer drugs and the time of rest is designated as a course of chemotherapy. As part of the first course of chemotherapy, the dosage of the drug or drugs that are administered intravenously or in the form of tablets and suspensions is clearly prescribed according to the scheme. Their intensity of administration; quantitative limits of rest; doctor visits; passing the tests provided for in the schedule of this cycle; clinical studies - all this is scheduled within one cycle, almost in seconds.

The number of cycles is prescribed by the attending physician, based on the following factors: stage of cancer; variant of lymphoma; the name of the drugs that are administered to the patient; the goal that the doctor wants to achieve:

• Or this is preoperative stopping chemistry to slow down or completely stop the division of malignant cells, which is carried out before surgery to remove the tumor.
• Or this is an “independent” course of treatment.
• Or a course of chemotherapy, which is carried out after surgery to destroy remaining cancer cells and prevent the formation of new tumor cells.
• Quite often this depends on the severity of side effects and their nature.

Only through monitoring and clinical research, which adds experience, is the doctor able to more effectively select a drug or a combination of drugs for the patient, as well as introduce the intensity and quantitative indicator of cycles into the treatment regimen, with minimal toxicity to the body and maximum ability to destroy cancer cells.

Chemotherapy course for lung cancer

Cancer patients with lung damage, today, are the leaders in quantitative manifestations. Moreover, this disease covers all countries of the globe, and the percentage of requests from patients with this diagnosis is growing every day. Statistics reveal quite frightening figures: for every hundred of those diagnosed with lung cancer, 72 people do not live even a year after diagnosis. The majority of patients are elderly (approximately 70% of patients are over 65 years of age).

Treatment of this disease is carried out comprehensively and one of the methods of control is chemotherapy, which especially gives high positive result in the case of small cell lung tumor.

It is quite difficult to recognize the disease at its early stage, since at first it is practically asymptomatic, and when pain begins to appear, it is often too late. But this does not mean at all that you need to give up and do nothing. Despite this, modern cancer centers have at their disposal diagnostic methods that make it possible to detect this terrible disease at an embryonic level, giving the patient a chance to live.

Differentiation of cancer cells and their classification occurs according to certain characteristics:

• Neoplasm cell size.
• The volume of the tumor itself.
• The presence of metastases and the depth of their penetration into other related organs.

Assigning a specific disease to an existing class is important, since for fine and coarse tumors, different stages of its growth, treatment methods are somewhat different. In addition, differentiation of the disease makes it possible to predict the further course of the disease, the effectiveness of specific therapy and the patient’s overall life prognosis.

A course of chemotherapy for lung cancer is aimed at damaging tumor growths. In some cases, it is used as an individual treatment method, but more often it is part of a general treatment complex. Small cell cancer responds especially well to chemicals.

The patient almost always receives cytostatics orally through a drip. Each patient receives the dosage and regimen individually from his attending physician. After completing one course of chemotherapy, the patient receives two to three weeks of rest in order to at least partially restore strength and prepare his body for a new dose of drugs. The patient receives as many treatment cycles as prescribed by the protocol.

The list of cytostatics used for lung cancer is quite wide. Here are some of them:

Carboplatin (Paraplatin)

This drug is given intravenously over 15 minutes to one hour.

The solution is prepared immediately before the dropper by diluting one bottle of the drug with a 0.9% sodium chloride solution or a 5% glucose solution. The concentration of the resulting mixture should be no more than 0.5 mg/ml carboplatin. The total dose is calculated individually in the amount of 400 mg per m 2 of the patient’s body surface. The rest period between doses is four weeks. A lower dosage is prescribed when the drug is used in combination with other medications.

Precautionary measures for using the drug during chemotherapy:

• This medicine is used only under the close supervision of the attending oncologist.
• Therapy can begin only with complete confidence in the correctness of the diagnosis.
• When using the medication, you must work only with gloves. If the medicine gets on the skin, it should be washed off as quickly as possible with soap and water, and the mucous membrane should be rinsed thoroughly with water.
• With significant doses of the drug, bone marrow suppression, severe bleeding and the development of infectious disease.
• The appearance of vomiting can be stopped by taking antiemetics.
• There is a possibility of allergic reactions. In this case, it is necessary to take antihistamines.
• Contact of carboplatinom with aluminum leads to a decrease in the activity of the drug. Therefore, when administering the drug, you cannot use needles that contain this chemical element.

There is no data on the use of the drug in the treatment of children.

Cisplatin (Platinol)

The drug is administered via a dropper intravenously. The dosage is determined by the doctor: - 30 mg per m 2 once a week;

• - 60–150 mg per m2 of patient’s body area every three to five weeks;
• - 20 mg/m2 daily for 5 days. Repeat every four weeks;
• - 50 mg/m2 on the first and eighth days every four weeks.

In combination with radiation, the drug is administered intravenously at a dose of up to 100 mg daily.

If the doctor has prescribed intraperitoneal and intrapleural administration of the drug, the dose is set from 40 to 100 mg.

When injecting the drug directly into the cavity, the drug is not greatly diluted.

Contraindications include both hypersensitivity to the components of the drug and impaired renal function and hearing.

Docetaxel

The medicine is administered slowly, once, intravenously, over 1 hour. At a dosage of 75–100 mg per/m2, the procedure is repeated every three weeks.

When taking the drug, you must observe all the precautions that are specified when working with other antitumor drugs.

Almost all chemotherapy drugs have many side effects, therefore, in order to remove some of them, the attending physician prescribes additional medications to his patient that partially or completely relieve them. The most common side effects:

• Hair loss.
• Peripheral neuropathy.
• Nausea progressing to vomiting.
• The appearance of ulcers in the mouth.
• Disorders in the digestive tract.
• Decreased vitality: fatigue, loss of appetite, depression.
• Change in taste preferences.
• A decrease in the number of red cells in the blood is anemia.
• A decrease in the number of white cells in the blood is neutropenia.
• Decreased platelet count.
• Immune suppression.
• Changes in the structure and color of nails, skin color.

The recovery process after a treatment cycle, in most cases, lasts approximately six months.

Chemotherapy course for lymphoma

Lymphoma is tumor cells that have penetrated the human lymphatic system, as well as organs located close to the lymph nodes. One of the first symptoms of cancer in lymphoma is swelling various groups lymph nodes (inflammation can affect either a separate group of nodes - inguinal, axillary, cervical localizations - or all of them in a complex). The use of chemotherapy for lymphoma gives fairly good results and an optimistic prognosis. Doctors distinguish between sclerotic nodular and combined forms of lymphoma. The stages of the disease, as with cancers of other organs, are distinguished: mild, moderate and severe. A more advanced form often leads to death.

The course of chemotherapy is prescribed based on the severity of the disease, as well as depending on the composition of the lymphatic fluid. Despite the different localization of the disease, diagnostic methods and chemotherapy schedules are quite similar. What distinguishes them is the drugs the patient receives and their combinations. Lymphomas cannot be operated on, so a course of chemotherapy is one of the main paths to healing. Traditionally, when treating lymph cancer, the patient undergoes three cycles; for more severe forms, the number of courses increases.

To confirm the diagnosis, except computed tomography MRI, positron emission tomography (PET) and other techniques are used, since the unifying name “lymphoma” includes a fairly large number of different diseases. But, nevertheless, the regimens for taking anticancer drugs are similar, and the same set of drugs is used. At an early stage of the disease, several protocol-approved regimens of combined chemotherapy drugs are used in combination with laser therapy.

The list of such drugs is quite wide. Here are some of them.

Adriamycin

The medicine is delivered in venumg/m2, once every three to four weeks. Or for three days pomg/m2 after three to four weeks. Or on the first, eighth and 15th days, once, 30 mg/m2. The intervals between cycles are 3-4 weeks.

If the medication is administered inside the bladder, the dropper is placed once with an interval of one week to a month.

Complex therapy involves a dropper every week at a dosage of mg/m2, but the total course dose should not exceed mg/m2.

The drug in question is contraindicated for people hypersensitive to hydroxybenzoates, suffering from anemia, impaired liver and kidney function, acute hepatitis, ulcerative manifestations in the stomach and duodenum, and others (a full list of contraindications can be read in the instructions for this medicine).

Bleomycin

The antitumor agent is prescribed both into the muscle and into the vein.

• for injections into a vein: the bottle of medication is diluted with a solution (20 ml) of sodium chloride. The medication is administered at a fairly measured pace.
• when injected into a muscle, the drug is dissolved in an isotonic sodium chloride solution (5-10 ml). To dull the pain, first inject 1-2 ml of a 1-2% novocaine solution.

The usual regimen for adults is 15 mg every other day or 30 mg twice a week. The total course dose should not exceed 300 mg. When repeating a cycle, both the single and course doses are reduced, the interval between doses of the drug is maintained for up to one and a half to two months. For elderly patients, the dose taken is reduced and is 15 mg twice a week. This drug is administered to babies carefully. The dose is calculated depending on the body weight of the toddler. When injecting, only freshly prepared solution is used.

The contraindications of this drug are significant: these include impaired renal and respiratory function, pregnancy, severe disease of the cardiovascular system...

Vinblastine

This drug is given through a drip and only intravenously. The dosage is strictly individual and directly depends on the patient’s clinic.

For adults: a single starting dosage of 0.1 mg/kg of patient weight (3.7 mg/m2 body surface), repeated every other week. For the next administration, the dose is increased by 0.05 mg/kg per week and adjusted to maximum dose per week - 0.5 mg/kg (18.5 mg/m2). An indicator of stopping the increase in the dose of the administered drug is a decrease in the number of leukocytes to 3000/mm 3.

The prophylactic dosage is 0.05 mg/kg less than the initial dose and is taken every 7-14 days until all symptoms go away.

For children: the starting amount of the drug is 2.5 mg/m2 once a week, the dose is gradually increased by 1.25 mg/m2 every week until the number of leukocytes decreases to 3000/mm3. The maximum total dose of a week is 7.5 mg/m2.

The maintenance dosage is lower by 1.25 mg/m2, which the child receives for 7–14 days. The bottle of the drug is diluted with 5 ml of solvent. Subsequently, if necessary, dilute with 0.9% sodium chloride solution.

This medicine is not advisable for patients who suffer from hypersensitivity to the active substance or any component of the drug, as well as viral or bacterial infections.

The number of chemotherapy courses administered is prescribed by the attending physician based on the clinical picture of the disease and the general condition of the patient.

Chemotherapy course for stomach cancer

Stomach cancer is a cancerous tumor that invades the stomach lining. It is capable of metastasizing into the layers of organs adjacent to the lesion; more often this penetration occurs in the liver, lymphatic system, esophagus, bone tissue and other organs.

At the initial stage of the onset of the disease, the symptoms of this disease are practically invisible. And only as the disease progresses, apathy appears, appetite disappears, the patient begins to lose weight, taste intolerance to meat food appears, and a blood test shows anemia. Subsequently, some discomfort begins to be felt in the stomach area. If the cancerous tumor is located close enough to the esophagus, the patient feels early saturation of the stomach, its fullness. appear internal bleeding, nausea, vomiting becomes more active, and severe pain appears.

A course of chemotherapy for stomach cancer is carried out either intravenously or in the form of tablets. This treatment complex is carried out either before surgery in order to at least slightly reduce the size of the tumor itself, or after surgery - to remove possibly remaining cancer cells after resection or to prevent relapses.

Oncologists use cytotoxic drugs to destroy tumor cells. Modern pharmacology offers a fairly impressive list of them.

The course of chemotherapy is represented by the following drugs:

Cisplatin, which has already been described above.

Fluorocil

It is quite often introduced into various treatment protocols. The patient takes it into a vein. They stop administering it when leukocytes reach a critical level. After normalization, the treatment process resumes. This medication is dripped continuously for hours at a rate of 1 g/m2 per day. There is another course, where the patient receives the medicine on the first and eighth days at a dosage of 600 mg/m2. It is also prescribed in combination with calcium, then the volumes are 500 mg/m2 daily for three to five days with an interval of four weeks.

Patients who suffer from individual intolerance to the components of this drug, suffer from renal or liver failure, acute form infectious disease, tuberculosis, as well as in a state of pregnancy or lactation, take this drug Not recommended.

Epirubicin

The medicine is delivered to the patient by jet injection into a vein. It is necessary to ensure that the drug does not get into other tissues, as it can provoke deep damage, even necrosis.

Adults: As a mono drug - intravenously. Dosage mg/m2. The break in the administration of the oncological drug is 21 days. If there is a history of bone marrow pathology, the administered dosage is reduced to 1 mg/m2.

If an anticancer drug is taken together with other drugs, its dosage is reduced accordingly.

Temperature after a course of chemotherapy

After any course of chemotherapy, the patient’s body is weakened, the immune system is severely suppressed, and against this background, frequent viral infections, which provoke a rise in the patient’s body temperature. Therefore, the general treatment of the patient is carried out fractionally, in separate cycles, in between which the patient’s body is given the opportunity to come to its senses and restore the spent protective forces. The fact that the temperature rises after a course of chemotherapy tells the attending physician that the patient’s body is infected and can no longer cope with the disease. It is necessary to include antibiotics in the treatment protocol.

The disease develops rapidly, therefore, in order to prevent complications, treatment must be started immediately. To determine the causative agent of inflammation, the patient takes a blood test. Having identified the cause, the effect can also be treated.

Unfortunately, an increase in temperature against the background of a general weakening of the body is an inevitable consequence of a course of chemotherapy. During this period, the patient simply needs to narrow the circle of contacts. You cannot take antipyretics.

What to do after a course of chemotherapy?

After spending quite a long time in the hospital, patients ask their oncologist a question. What to do after a course of chemotherapy?

The main thing that patients need to remember is:

• The patient must be seen for a follow-up examination with an oncologist. The first appointment will be made by the attending physician at the hospital, and the patient will receive a further schedule of visits from the doctor at the clinic.
• At the slightest manifestation of a symptom, you urgently need to see a doctor again:
  • Diarrhea and nausea.
  • Pain that lasts for several days.
  • Unreasonable weight loss.
  • The appearance of swelling and bruising (if there was no injury).
  • Dizziness.
• Cancer is not dangerous. Therefore, you should not limit the patient’s communication with relatives and friends. Positive emotions also heal.
• If the body has returned to normal after a course of chemotherapy, you should not avoid intimacy, it is an integral part of full life. It is impossible to infect your partner with cancer, but ruining your relationship is quite possible.
• After all chemotherapy courses are over, the rehabilitation process has been completed, vitality has been restored, there is no reason to give up professional activities. Former patients may well return to work, especially if it does not involve heavy physical labor. In a rainy day, you can find a place where the work is easier.
• As we recover immune system body, vitality, the former patient can gradually return to his usual level of activity. Go out in public, go to work, take a walk in the park - this will give you the opportunity to take your mind off your problems and push them into the background.

Recovery after a course of chemotherapy

Cancer patient after general treatment feels pretty bad. The functions of all organs and systems are reduced. Recovery after a course of chemotherapy includes the need to help the patient return his body to normal working condition as quickly as possible. Support in the desire to return to a full social life.

In most cases, this process takes about six months. IN recovery period the patient undergoes rehabilitation courses developed by specialists, which will cleanse the body of the effects of chemotherapy, protect against the penetration of pathogenic flora (taking antibiotics), stimulate the body to become more active, help consolidate the results obtained and prevent complications.

The recovery period consists of several stages or courses:

• Restorative drug therapy, carried out in a hospital setting.
• Rehabilitation at home.
• Traditional medicine.
• Spa treatment.

The patient undergoes the initial course of rehabilitation therapy while still in the hospital. And since the liver is the first to take the blow of chemotherapy, it needs to be supported even during the treatment itself. She also needs support during rehabilitation. To improve the functioning of the liver, the patient is prescribed supportive medications, often made from natural plant materials, for example, “Karsil”, which is based on milk thistle.

Adults take these pills three times a day, one to four pieces (as prescribed by the doctor, depending on the severity of the disease). The duration of treatment is more than three months.

For children over five years of age, the daily dose of the drug is prescribed at the rate of 5 mg per 1 kg of the child’s body weight. The resulting figure is divided into three steps.

This medicine has a number of minor side effects. The main one is dyspepsia, disruption of the normal functioning of the stomach, problematic digestion that occurs with painful sensations. Less common are disorders of the vestibular apparatus and alopecia (pathological hair loss), but they usually resolve on their own. There is only one contraindication for use - hypersensitivity to any of the components of the drug.

Good helpers in cleansing the body are adsorments, which, like a sponge, absorb, bind toxins and remove them. These modern enterosorbents have an extensive adsorbing surface. This makes them highly effective.

This medicine is available in the form of a paste completely ready for use. The duration of the course is purely individual and is prescribed by the attending physician caring for the patient, but on average from a week to two. Take one and a half to two hours before or after a meal or medical supplies, three times a day. A single dosage for adults or adolescents over 14 years of age is 15 g (corresponding daily dose is 45 g).

Toddlers from zero to five years old are prescribed a teaspoon (5 g) - a single dose or 15 g - a daily dose. For children from five to 14 years old, respectively: daily dose– 30 g, one-time – 10 g.

In case of severe manifestations of the effects of chemotherapy, the dosage can be doubled in the first three days, and then returned to the recommended dosage. Side effects of this drug are also observed - constipation (if the patient was already prone to their manifestation). The drug is contraindicated for use in patients who have a history of acute intestinal obstruction, allergic reaction on the component composition of the drug.

This sorbent is drunk in the form of an aqueous mixture, which is prepared immediately before use: in one glass of not hot boiling water or mineral water(without gas) of neutral alkalinity, the powder of the drug is administered: for adults - 1.2 g (one tablespoon), for children - 0.6 g (one teaspoon). The solution is mixed thoroughly. The resulting suspension is taken one hour before taking medications or food. In this case, the daily dosage of the drug for adults and children over seven years of age is 12 g (if there is a medical need, the dose can be increased to 24 g per day).

For children aged from one to seven years, the daily dosage is determined at the rate of mg per 1 kg of the child’s weight and is divided into three to four doses. A single dose should not be more than half the daily dosage. If it is difficult for a patient to take the medicine on his own, it is administered to him through a tube.

The course of treatment is purely individual and ranges, on average, from 3 to 15 days. There are few contraindications for this drug. These include acute periods peptic ulcers duodenum and stomach, damage to the mucous membrane of the small and large intestines (erosions, ulcers), intestinal obstruction. You should not give Polysorb to children under one year of age.

After discharge from the hospital, the patient needs to radically change his previous lifestyle and diet. To prevent pathogenic flora from entering the body, it is necessary to take care of the oral cavity (oral cavity, brush teeth...). At first, give up solid food or drink it well with liquid so that it passes through the esophagus more easily without causing injury.

Exposure to chemicals on the body leads to disturbances in the blood supply system, and the blood formula itself changes. To increase hemoglobin, the doctor prescribes the patient to take red wine in small doses (although it is not recommended to drink alcohol itself after such a complex procedure as chemotherapy). During this period, the patient also takes venotonics.

For example, venarus is an angioprotector that raises vascular tone, prevents stagnation of venous blood in the vessels, and improves its microcirculation. Take one or two tablets twice a day (during lunch and dinner). This drug is not recommended for use in patients who have increased sensitivity to the components of the drug (complete intolerance is rare).

To increase platelets in the blood, the attending physician prescribes B vitamins to the patient, as well as Sodecor and Derinat, and some others.

This medication is injected intramuscularly (less commonly subcutaneously). Adults receive a single dosage of 5 ml. The patient receives an injection every hour as prescribed by the doctor. The course of treatment involves about three to ten injections.

The drug administration schedule for children is similar. And the single dose varies:

• toddlers under two years of age - 0.5 ml of the drug.
• from two to ten years - 0.5 ml of medicine, calculated for each year of life.
• over ten years old - 5 ml of the drug Derinat.

This medicine is contraindicated in patients who suffer from individual intolerance to sodium deoxyribonucleate or diabetes mellitus.

The daily dosage of the drug is from 15 to 30 ml (diluted with 200 ml of water or warm tea) divided into one to three doses. The duration of treatment is from three weeks to a month. The solution must be shaken well before use.

The drug Sodecor is contraindicated in case of hypersensitivity to its components or arterial hypertension.

During the recovery period, the course of treatment with folk remedies should not be neglected.

To overcome such a consequence of chemotherapy as baldness, you can use the experience of our ancestors:

• Rub burdock oil, which is sold in any pharmacy, into the roots of the head.
• In this case, an infusion of rowan and rose hips works well. You need to drink three glasses daily.
• Decoctions for washing hair made from burdock root or hops.
• Berry fruit drinks have an excellent effect.
• And others.

The following will help the patient increase the number of leukocytes, hemoglobin, platelets, and red blood cells in the blood (normalize its formula):

• Decoctions prepared from herbs such as chicory, sweet clover, and angelica root.
• Tincture or decoction of golden root.
• Nettle decoction.
• Eleutherococcus tincture.
• A decoction based on yarrow herb.
• And other herbs.

For hematomas in the vein area good efficiency show vodka compresses, which are topped with plantain or cabbage leaves.

And as a final chord rehabilitation period is a sanatorium-resort treatment, as well as climatotherapy, as an integral part of a comprehensive sanatorium treatment.

Due to the increasing number of cancer diseases, specialized sanatoriums have become an indispensable stage of the rehabilitation period. Special programs are being developed that include:

• Taking mineral water.
• The use of herbal medicine (herbal treatment).
• Selection of an individual balanced diet.

Physiotherapeutic procedures in the recovery period after chemotherapy:

• Iodine baths.
• Yoga class.
• Water procedures with sea salt.
• Aromatherapy is treatment with scents.
• Health-improving physical education.
• Therapeutic swimming.
• Working with a psychologist. Getting positive emotions, relieving stress.
• Climatic therapy: walks in the fresh air (often sanatoriums are located in picturesque places remote from industrial zones).

Nutrition after chemotherapy

Food during treatment has important functions of recovery. Nutrition after a course of chemotherapy is a real weapon to return to a normal, fulfilling life. Food during this period should be balanced. Especially on the table of a former patient, products should appear that will help put a barrier to malignant neoplasms, working both for treatment and prevention.

Products required in the diet:

• Broccoli. It contains isothiocyanate. It is capable of destroying cancer cells.
• Porridge and grain flakes.
• Brown rice and nuts.
• Vegetables and fruits. It is advisable to eat vegetables raw or stewed.
• Legumes must be present in the diet.
• Fish.
• It is better to limit the consumption of flour products. Only wholemeal bread.
• Honey, lemon, dried apricots and raisins - these products can significantly increase hemoglobin.
• Freshly squeezed juices, especially from beets and apples. They will introduce vitamins C, P, group B and microelements into the body.
• Herbal teas: with blackcurrant, rosehip, oregano...

• Black tea and coffee.
• Alcohol.
• Fast food.
• Toxic products.
• Products containing dyes, stabilizers, preservatives...

Many people perceive the word cancer as a death sentence. Don't despair. And if trouble comes to your home, fight it. Work in the field of oncology is being carried out “on all fronts”: innovative treatment methods, increasing the quality of anti-cancer drugs themselves, developing rehabilitation complexes after all medical procedures. Thanks to the achievements recent years, the course of chemotherapy has become less painful, and the percentage of victories in the collaboration between doctor and patient is pleasantly increasing, which means that another step has been taken in the fight against this terrible disease. Live and fight! After all, life is wonderful.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University them. A.A. Bogomolets, specialty - “General Medicine”

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ATTENTION! SELF-MEDICATION CAN BE HARMFUL FOR YOUR HEALTH!

Be sure to consult with a qualified specialist so as not to harm your health!

In the structure of oncological diseases, lung cancer is one of the most common pathologies. It is based on malignant degeneration of the epithelium of the lung tissue and impaired air exchange. The disease is characterized by high mortality. The main risk group consists of smoking men aged 50-80 years. A feature of modern pathogenesis is a decrease in the age of primary diagnosis, an increase in the likelihood of lung cancer in women.

Small cell cancer is a malignant tumor that has the most aggressive course and widespread metastasis. This form accounts for about 20-25% of all types. Many scientific experts regard this type of tumor as a systemic disease, in the early stages of which it is almost always present in regional lymph nodes. , suffer from this type of tumor most often, but the percentage of cases is growing significantly. Almost all patients have a fairly severe form of cancer, which is associated with rapid tumor growth and widespread metastasis.

Small cell lung cancer

Causes of small cell lung cancer

In nature, there are many reasons for the development malignant neoplasm in the lungs, but there are basic ones that we encounter almost every day:

• smoking;
• radon exposure;
• pulmonary asbestosis;
• viral infection;
• dust exposure.

Clinical manifestations of small cell lung cancer

Symptoms of small cell lung cancer:

• a cough of a prolonged nature, or a new cough with changes in the patient’s usual cough;
• lack of appetite;
• weight loss;
• general malaise, fatigue;
• shortness of breath, pain in the chest and lungs;
• voice change, hoarseness (dysphonia);
• pain in the spine and bones (occurs with bone metastases);
• epilepsy attacks;
• Lung cancer, stage 4 - speech impairment occurs and severe headaches appear.

Grades of small cell lung cancer

• Stage 1 - the tumor size is up to 3 cm in diameter, the tumor has affected one lung. There is no metastasis.
• Stage 2 – the size of the tumor in the lung is from 3 to 6 cm, blocks the bronchus and grows into the pleura, causing atelectasis;
• Stage 3 - the tumor rapidly spreads to neighboring organs, its size has increased from 6 to 7 cm, and atelectasis of the entire lung occurs. Metastases in neighboring lymph nodes.
• Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs of the human body and causes symptoms such as:

1. headache;
2. hoarseness or loss of voice altogether;
3. general malaise;
4. loss of appetite and a sharp decline in weight;
5. back pain, etc.

Diagnosis of small cell lung cancer

Despite all the clinical examinations, history taking and listening to the lungs, quality is also necessary, which is carried out using methods such as:

• skeletal scintigraphy;
• chest x-ray;
• detailed, clinical blood test;
• computed tomography (CT);
• liver function tests;
• magnetic resonance imaging (MRI)
• positron emission tomography (PET);
• sputum analysis ( cytological examination for the purpose of detecting cancer cells);
• thoracentesis (sampling of fluid from the chest cavity around the lungs);
• – the most common method for diagnosing malignant neoplasms. It is carried out in the form of removing a particle of a fragment of the affected tissue for further examination under a microscope.

There are several ways to perform a biopsy:

• bronchoscopy in combination with biopsy;
• carried out using CT;
• endoscopic ultrasonography with biopsy;
• mediastinoscopy in combination with biopsy;
• open lung biopsy;
• pleural biopsy;
• videothoracoscopy.

Treatment of small cell lung cancer

Chemotherapy occupies the most important place in the treatment of small cell. Without appropriate treatment for lung cancer, the patient dies 5-18 weeks after diagnosis. Polychemotherapy helps to increase the mortality rate to 45–70 weeks. It is used both as an independent method of therapy and in combination with surgical intervention or radiation therapy.

Purpose this treatment, is complete remission, which must be confirmed by bronchoscopic methods, biopsy and bronchoalveolar lavage. As a rule, the effectiveness of treatment is assessed 6-12 weeks after the start of therapy, and based on these results, the likelihood of cure and the patient’s life expectancy can be assessed. The most favorable prognosis is for those patients who achieve complete remission. This group includes all patients whose life expectancy exceeds 3 years. If the tumor has decreased by 50%, and there is no metastasis, it is possible to talk about partial remission. Life expectancy is correspondingly shorter than in the first group. For tumors that cannot be treated and are actively progressing, the prognosis is poor.

After a statistical study, the effectiveness of chemotherapy was revealed and is about 70%, while in 20% of cases complete remission is achieved, which gives survival rates close to those of patients with a localized form.

Limited stage

At this stage, the tumor is located within one lung, and nearby lymph nodes may also be involved.

Treatment methods used:

• combined: chemo+radiation therapy followed by prophylactic cranial irradiation (PCR) during remission;
• chemotherapy with or without PCO, for patients who have deteriorating respiratory function;
• surgical resection with adjuvant therapy for patients with stage 1;
• The combined use of chemotherapy and thoracic radiotherapy is the standard approach for patients with limited-stage, small cell LC.

According to clinical trial statistics, combination treatment compared to chemotherapy without radiation therapy increases the 3-year survival prognosis by 5%. Drugs used: platinum and etoposide. Prognostic indicators for life expectancy are 20-26 months and a 2-year survival rate of 50%.

Ineffective ways to increase your forecast:

• increasing the dose of drugs;
• effect of additional types of chemotherapy drugs.

The duration of the chemotherapy course is not defined, but, nevertheless, the duration of the course should not exceed 6 months.

Question about radiation therapy: Many studies show its benefits during 1-2 cycles of chemotherapy. The duration of the course of radiation therapy should not exceed 30-40 days.

Maybeapplication of standard radiation courses:

• 1 time per day for 5 weeks;
• 2 or more times a day for 3 weeks.

Hyperfractionated thoracic radiotherapy is considered preferable and results in a better prognosis.

Older patients (65-70 years old) tolerate treatment much worse; the treatment prognosis is much worse, since they respond rather poorly to radiochemotherapy, which in turn manifests itself in low effectiveness and major complications. Currently, the optimal therapeutic approach for elderly patients with small cell cancer has not been developed.

Patients who have achieved remission of the tumor process are candidates for prophylactic cranial irradiation (PCR). Research results indicate a significant reduction in the risk of metastases in the brain, which is 60% without the use of PCO. PCO improves the prognosis of 3-year survival from 15% to 21%. Often, survivors experience impairments in neurophysiological function, but these impairments are not associated with undergoing PCO.

Extensive stage

The tumor spreads beyond the lung in which it originally appeared.

Standard therapy methods:

• combination chemotherapy with or without prophylactic cranial irradiation;
• +

  Note! The use of increased doses of chemotherapy drugs remains an open question.

  For limited stage, in case of a positive response to chemotherapy, extensive stage small cell lung cancer, prophylactic cranial irradiation is indicated. The risk of metastases in the central nervous system within 1 year is reduced from 40% to 15%. No significant deterioration in health was detected after PCO.

  Combined radiochemotherapy does not improve the prognosis compared to chemotherapy, but thoracic irradiation is advisable for palliative treatment of distant metastases.

  Patients diagnosed with an advanced stage have a deteriorating health status, which complicates aggressive therapy. Clinical studies have not revealed an improvement in survival prognosis when reducing drug doses or switching to monotherapy, but, nevertheless, the intensity in this case should be calculated from an individual assessment of the patient’s health status.

  Disease prognosis

  As mentioned earlier, small cell lung cancer is one of the most aggressive forms of all. The prognosis of the disease and how long patients live depends directly on the treatment of lung cancer. A lot depends on the stage of the disease and what type it is. There are two main types of lung cancer - small cell and non-small cell.

  Small cell lung cancer affects smokers; it is less common, but spreads very quickly, forming metastases and affecting other organs. It is more sensitive to chemical and radiation therapy.

  Life expectancy in the absence of appropriate treatment ranges from 6 to 18 weeks, and the survival rate reaches 50%. With the use of appropriate therapy, life expectancy increases from 5 to 6 months. The worst prognosis is for patients with a 5-year illness period. Approximately 5-10% of patients remain alive.

  Informative video

  9920 0

  Long-term results of treatment small cell lung cancer (SLC) remain unsatisfactory (Table 10), although, according to some data, they have improved over the previous decade.

  Over the past 20 years, as a result of the introduction of combined treatment methods, in particular combined chemotherapy (XT), there has been an improvement in survival outcomes with 5-year survival rates increasing from 5.2% in 1972-1981. to 12.2% in 1982-1996, the median survival rate over the same period increased from 11.8 to 18.8 months (9th World Conference on Lung Cancer, Japan, Tokyo, 2000).

  Table 10. Long-term results of treatment for SCLC

  One of the main treatment methods is XT using combination regimens. The surgical method is used at an early stage of the process (localized process). Meaning surgical method in the early stages, it is confirmed by studying the morphological variant of the malignancy of the process and clarifying the damage to the mediastinal lymph nodes.

  Radiation therapy is also a mandatory component of the treatment of a localized process. At complete regression (CR) can be used prophylactic cerebral irradiation (POBI).

  Localized small cell lung cancer

  At stage I of the disease it is used surgical treatment, followed by XT or chemotherapy with chest irradiation. Standard XT mode, as with non-small cell lung cancer (NSCLC), is the mode:

  Cisplatin IV 75-100 mg/m2 1 time per day on the 1st day against the background of overhydration and antiemetics
  +
  Etoposide IV drip 80-100 mg/m2 1 time per day on days 1, 2 and 34
  Every 3 weeks

  For a localized process, it is used in combination with radiation therapy at a total dose of 40-45 Gy, which should be carried out during the 1st or 2nd cycle.

  In such patients and patients with complete remission after chemotherapy, foreign authors use POGM. Patients with small cell lung cancer (SLC) must undergo a thorough, sometimes invasive examination to clarify the stage of the disease. The results of surgical treatment of localized SCLC allow achieving good 2-year survival rates.

  For localized stage II SCLC, surgery results in satisfactory local control after induction CT with radiation therapy. The presence of N2 is generally a contraindication to surgical treatment.

  However, in localized small cell lung cancer with stage IIIA PR after cytoreductive XT, it is possible to include surgery and then chemotherapy and then chemotherapy in the treatment plan radiation therapy (RT). The best prognostic factor is the absence of residual tumor in the removed specimen.

  According to Shepherd F.A. (2002), the 5-year survival rate of all operated patients is 25-35%:

  Undergo surgery (of all patients with SCLC) - 5%;

  undergo surgery after induction XT for SCLC - 75%:

  Of these, 8-100% (on average 50%) undergo radical surgery;
  - of these, histological complete regression - 0-37%;

  5-year survival rate for all operated patients is 25-35%:

  5-year survival rate for stage I small cell lung cancer - >50%;
  - 5-year survival rate after XT and RT - 20-25%.

  Similar results were obtained using alternating EC and CAV+RT regimens at a dose of 45 Gy.

  Following modeschemotherapycan be used for SCLC:
  
  

  Treatment regimens	Drugs (iv, drip), mg/m2	Interval, weeks
  EP	Cisplatin 80 on day 1 + etoposide 120 on days 1, 2, 3	3
  CAE	Cyclophosphamide 1000 on day 1 + doxorubicin 45 on day 1 + etoposide 100 on days 1, 2, 3 or 1, 3, 5	3
  CAV	Cyclophosphamide 1000 on day 1 + doxorubicin 50 on day 1 + vincoistin 1.4 on day 1	3
  VICE	Vincristine 1.4 on day 1 + ifosfamide 5000 on day 1 + carboplatin 300 on day 1 + etoposide 180 on days 1 and 2	3
  CDE	Cyclophosphamide 1000 on day 1 + doxorubicin 45 on day 1 + etoposil 100 on 1.3. 5th day	3
  CAM	Cyclophosphamide 1000-1500 on day 1 + doxorubicin 60 on day 1 + methotoexagt 30 on day 1	3
  AVP	Nimustine 3-2 mg/kg on day 1 + etoposide 100 on days 4, 5, 6 + cisplatin 40 on day 2. 8th days	4-6
  TEP	Paclitaxel 175 on day 1 + etoposide 100 on days 1, 2, 3 + cisplatin 75 on day 1	3-4

  
  Use of intensive XT regimens with increasing doses included in the regimens medicines (medicines), as a rule, leads to improved immediate treatment results. However, even in a tumor as sensitive to XT as SCLC, the advantage of high-dose regimens has not been proven.

  The optimal duration of chemotherapy for patients with localized small cell lung cancer has not been fully clarified, but no improvement in survival was observed when the duration of treatment was increased from 3 to 6 months.

  The risk of developing CNS metastases can be reduced by more than 50% by CNS irradiation at a dose of 24 Gy.

  When using chemoradiation treatment, the preferred hyperfractionation regimen is:

  Advanced small cell lung cancer

  In advanced SCLC, the median survival is 6-12 months, 5-year survival is 2.3%. Combination chemotherapy plus radiation therapy does not improve survival compared with chemotherapy alone. However, radiation therapy is important in the palliative treatment of symptoms of both the primary tumor and metastases, especially to the brain, meninges, and bones.

  A meta-analysis of 7 randomized studies showed the importance of CNS irradiation in patients with PR - a decrease in relapses in the CNS, improvement in relapse-free and overall survival were reported: 3-year survival increased from 15 to 21%.

  The following combination XT regimens provide similar survival:

  CAV (cyclophosphamide + doxorubicin + vincristine);
  CAE (cyclophosphamide + doxorubicin + etoposide);
  EP (etoposide + cisplatin);
  EU (etoposide + carboplatin);
  CAM (cyclophosphamide + doxorubicin + ethotrexate);
  ICE (ifosfamide + carboplatin + etoposide);
  CEV (cyclophosphamide + etoposide + vincristine);
  PET (cisplatin + etoposide + paclitaxel);
  CAEV (cyclophosphamide + doxorubicin + etoposide + vincristine).

  The greatest effectiveness (64.7%) against various visceral metastases is the regimen with nimustine - AVP, which turned out to be more effective against metastases in the central nervous system compared to other regimens.

  For brain metastases, radiation therapy, CT, and chemoradiotherapy are used:

  Of particular interest is the use of new drugs in previously untreated patients with advanced SCLC (Table 11).

  Table 11. Efficacy of new drugs in previously untreated patients with advanced small cell lung cancer

  New drugs are also being studied in combination chemotherapy regimens.

  They include 2- and 3-component treatment regimens, as well as combinations with radiation therapy:

  Treatment regimens	Drugs (iv, drip), mg/m2	Interval, weeks	Effect
  	Docetaxel 100 1 hour		23% CR
  	Paclitaxel 250 24 h + G-CSF		53% OE
  TS	Paclitaxel 175 on day 1 + carboplatin 400 on day 1	3-4
  TP	Docetaxel 75 on day 1 + cisplatin 75 on day 1	3-4
  TG	Paclitaxel 175 on day 1 + gemcitabine 1000 on days 1, 8, 15	4
  TEP	Paclitaxel 175 3 hours + cisplatin 80 + etoposide 80 IV on day 1, 160 orally on days 2-3 + G-CSF		83% OE 22% complete regression
  TEP	Paclitaxel 135 on day 1 + cisplatin 75 on day 1 + etoposide 80 on days 1-3		90% ME MB - 47 weeks
  GEP	Gemcitabine 800 on days 1, 8 + etoposide 50 on days 1-5 + cisplatin 75 on day 1		54% OE 75% - untreated patients
  IP	Irinotecan 60 on days 1, 8, 15 + cisplatin 50 on day 1 + radiation therapy 4 weeks		83% OE, 30% CR, MB 14.3 months - LP 86% EE, 29% CR, MB 13 months - RP
  CN	Carboplatin 300+ Vinorelbine 25 on days 1, 8 x 6 cycles		74% OE MB - 9 months

  PR - partial rammission, LP - localized process, ERP - widespread process

  Some results of comparing the effectiveness of the modes:

  With comparable effectiveness of the EP and TEP regimens (MB 9.84 months and 10.33 months, respectively), the toxicity of the 2nd regimen was higher;
  a study of the TP regimen as the 1st line of XT advanced SCLC in previously untreated patients showed its effectiveness in 59% of patients;
  data from the JCOG-9511 study (Japan) were obtained on the advantages of the IP mode compared to the standard EP scheme: MB 9.4 and 12.8, respectively; OE is 83 and 68%, respectively.

  In order to clarify the results, we are currently conducting additional research. In the therapy of SCLC, as well as in NSCLC, new directions are being explored drug treatment, having one main trend - from nonspecific antiproliferative drugs to targeted therapy, or what foreign authors call “targeted” therapy, aimed at specific genes, receptors, proteins, etc.

  V.A. Gorbunova, A.F. Marenich, 3.P. Mikhina, O.V. Izvekova

  Lung cancer is rightfully considered a serious disease and is the leading cause of death worldwide. The pathological process of formation of their epithelial cells has certain symptoms, these are:

  • continuous wet cough with bloody discharge;
  • dyspnea;
  • pleuritic pain.

  They may include signs of disruption of the normal functioning of other internal organs and systems. This terrible disease Most often they are treated comprehensively. And one of effective methods is chemotherapy.
  

  What is a chemotherapy treatment?

  Chemotherapy method

  Chemotherapy for lung cancer is treatment using antitumor drugs that can partially or completely destroy cancer cells. There are times when it is used as self-treatment, but this happens extremely rarely, because maximum effectiveness can only be achieved with combined surgical and radiation exposure. It all depends on the structure of the cancer tumor, which can be small cell or non-small cell.

  Through chemotherapy for lung cancer, all the necessary drugs enter the bloodstream and completely cover the blood supply.

  In this case, malignant cells are destroyed both internally and externally. Sometimes, in order to achieve a 100% effect, for example, when treating stage 3 lung cancer with chemotherapy, some drugs are combined with each other. Specific medications are taken both during the treatment process and during the rehabilitation period. All of them are selected individually, the optimal duration of the course of therapy is 3 weeks.

  Chemotherapy drugs for lung cancer are administered into the body in one of two ways:

  1. orally;
  2. intravenously.

  Modern chemical drugs are divided into the following groups:

  • alkylating cytostatics;
  • antimetabolites;
  • antibiotics;
  • herbal preparations, etc.

  Important! Hormones and antihormones are often used to inhibit active tumor growth.

  In medicine, there are developed chemotherapy regimens for lung tumors. They consist in determining which medications are prescribed first, as well as what dosages are allowed and what they can be combined with.

  The most common combinations are:

  If one course fails to achieve the desired effect, then a 2nd line of chemotherapy is carried out for lung cancer.

  The difficulty of treating tumors with chemicals is that malignant cells are not foreign to the body, because they were once completely normal. In view of this, it is currently impossible to create a unique medicine that would not adversely affect healthy cells, but at the same time destroy tumor elements.

  

  Chemotherapy is effective in conditions because it, through special drugs, affects malignant cells, which are considered as such due to their uncontrolled division. They affect the simplest units of structure at the moment when they reproduce. Accordingly, the more often its division occurs, the more effective the medicine is. When cancer internal organ is at the last stage of its development, then chemotherapy is more supportive in nature, i.e. alleviates the patient's condition, positively affecting his quality of life.

  But here we are faced with a problem, because together with pathological process There are many other absolutely normal processes in the life of cells that occur in the body, which also divide quite actively and come under the negative influence of chemotherapy drugs used to treat cancer. This applies to elementary structural units:

  1. bone marrow;
  2. skin;
  3. hair follicles;

  As a result, the person being treated is forced to suffer from respiratory cancer in the form of disturbances in hematopoietic processes, hair loss, nausea and frequent diarrhea. But for many people, it's better than just dying from cancer. Many people are interested in the question “How long do they live after chemotherapy?” and, regardless of what symptoms accompany lung cancer, after such treatment the patient can live about 5 more years.
  

  Proper nutrition

  Despite all the aggressiveness of the chemical method of influencing the tumor, sometimes there is simply no other chance and the patient is ready to do anything just to save his life. Often the consequences of such treatment are depression, nausea and many other sufferings. You can cope with this with proper nutrition during chemotherapy for lung carcinoma. The main task of the diet is to provide the body with nutrients and microelements in quantities that will be sufficient for its normal functioning. It is important to stimulate the desire to eat, which disappears almost after the start of treatment, as well as to eliminate nausea.

  So, in the conditions of treatment with chemicals for squamous cell carcinoma or its other form, food products containing proteins will contribute to the renewal of the body at the genetic level:

  1. lean meat;
  2. bird;
  3. Fish and seafood;
  4. eggs.

  In addition, the daily diet should contain antioxidants, in the form of:

  • milk;
  • fermented milk products;
  • croup;
  • flour products.

  

  In order to restore the desire to eat, you should eat food quite often, but in very small doses. Moreover, it should be enough to restore energy losses. Do not neglect flavorings and fresh spices, as well as sour juices, which can increase appetite. You can suppress nausea if you consume a large number of liquids, about 3 liters per day.

  Nutrition after chemical therapy remains essentially the same. As a supplement, patients are recommended to use table No. 15 according to Pevzner. The source of protein can be not only meat, but also milk porridge, bread, and baked goods. Once a week you can eat boiled sausage and frankfurters. Some scientists recommend limiting the amount of calories consumed. In their opinion, moderate nutrition, on the contrary, promotes intensive recovery of the body. In any case, only healthy eating, which does not include fried, spicy and fatty foods.