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ЛЕЧЕНИЕ МЕЛКОКЛЕТОЧНОГО РАКА ЛЕГКОГОМелкоклеточный рак легкого характеризуется быстрым развитием, ранним интенсивным лимфогенным и гематогенным метастазированием и плохим прогнозом. У 80 - 90% больных диагностируют распространенный опухолевый процесс. Поэтому многие годы мелкоклеточный рак считали «терапевтическим» и противопоказанием к хирургическому лечению. Сочетанное применение комбинированной химиотерапии и лучевой терапии МРЛ давно получило всеобщее признание и подтверждено многочисленными рандомизированными исследованиями [146, 147]. В настоящее время при I - II стадии, особенно неовсяноклеточном морфологическом подтипе МРЛ, возможно хирургическое лечение с последующей полихимиотерапией (до 6 курсов). Некоторые исследователи считают целесообразным проведение неоадъювантной (2 - 4 курса) и адъювантной полихимиотерапии даже при III стадии МРЛ. Пятилетняя выживаемость после комбинированного лечения в сочетании с хирургическим методом при I - II стадии составляет 28 - 36%, лучшие результаты достигаются при отсутствии метастазов в лимфатических узлах (45 - 49%). При III (N2+) стадии сведения противоречивы - более 5 лет переживают от 5 до 40% больных [8, 148 - 152]. Задача лучевой терапии при комбинированном лечении - улучшить локальный контроль. Профилактическое облучение головного мозга показано пациентам с полной ремиссией при исходно ограниченном (I - II стадия) опухолевом процессе [153]. Больным с неоперабельным МРЛ III - IV стадии проводят консервативную противоопухолевую терапию, сочетая химиотерапию с лучевой [8, 154]. Современные методики такого лечения позволяют у 80 - 90% больных получить непосредственный объективно регистрируемый эффект, у 20 - 30% из них - полную регрессию опухоли. Достижение полной клинической ремиссии после основного курса лечения увеличивает выживаемость больных и открывает перспективу излечения.
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