Optimal Radiation Therapy for Small Cell Lung Cancer
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Radiation therapy plays an important role in the management of both limited stage and extensive stage small cell lung cancer. For limited stage disease, there has been a trend toward reduced size of thoracic radiation fields, which has the potential to reduce toxicity. FDG-PET staging helps make this possible by more accurately identifying areas of nodal and metastatic involvement. Trials have demonstrated similar outcomes using a range of radiation fractionation schedules, allowing flexibility in individualizing treatment. Using advanced radiation therapy techniques such as intensity-modulated radiation therapy, it may be possible to deliver fewer, higher dose fractions and achieve similar results to the hyperfractionated regimen. For extensive stage disease, consolidative thoracic radiation therapy after chemotherapy was recently shown to improve overall survival in certain patient subsets. Prophylactic cranial irradiation continues to play an important role in management of all stages of small cell lung cancer. Debate continues about the neurocognitive effects of this treatment, and whether MRI surveillance is an acceptable alternative. Strategies such as hippocampal avoidance may reduce the cognitive effects of prophylactic cranial irradiation in the future. Finally, in the last few years stereotactic ablative radiation therapy followed by chemotherapy has emerged as a promising treatment for stage I small cell lung cancer. This radiation treatment is usually given over 1–5 fractions and appears to provide a good rate of local control with a low rate of serious toxicity.
KeywordsSmall cell lung cancer Radiation therapy Intensity-modulated radiation therapy
Compliance with Ethical Standards
Conflict of Interest
Michael F. Gensheimer has received research support through a grant from the Varian Medical Systems.
Billy W. Loo, Jr. has received research support through grants from the Varian Medical Systems and RaySearch Laboratories and educational lecture honoraria from the Varian Medical Systems. Dr. Loo is also a board member of TibaRay, Inc.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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