Modern radiotherapy in limited and extensive stage small-cell lung cancer

Abstract

Small-cell lung cancer (SCLC) represents for approximately 10–15 % all lung cancers. Typically, SCLC presents in senior patients (>70 years) with a substantial smoking history. According to historic Veteran’s Administration Lung Study Group staging criteria, SCLC is simply divided into two respective stages: limited stage (LS-SCLC) and extensive stage SCLC (ES-SCLC). Despite fundamental improvements in imaging and treatment modalities, prognosis of SCLC patients is still poor with median survival ranges of only 15–20 months for LS-SCLC and 8–13 months for ES-SCLC. Unless diagnosed quite early, which constitutes only less than 5 % of all SCLC patients, surgery currently has little or almost no role in the standard management of SCLC. Therefore, surgery is recommended for only medically fit stage I SCLC patients with peripherally located lesions. Based on the results of multiple randomized controlled trials and/or meta-analyses, the optimal treatment of LS-SCLC is cisplatin-etoposide (EP)-based concurrent chemoradiotherapy (45 Gy b.i.d thoracic radiotherapy) followed by prophylactic cranial irradiation (PCI: 25 Gy in ten fractions) for every patients with any objective response after chemoradiotherapy. Similarly, evidence-based treatment of ES-SCLC includes EP combination chemotherapy followed by thoracic radiotherapy and PCI in patients with any objective response. In order to achieve best results, the thoracic radiotherapy and chemotherapy should be integrated as soon as possible (preferably at first course of chemotherapy), and the overall interval between the start of chemotherapy and the completion of thoracic radiotherapy should be kept as short as possible, namely, <30 days.