Limited-Disease Small-Cell Lung Cancer

Abstract

About one-third of all patients with small cell lung cancer present with their disease confined to thorax. In the last two decades, combined radiation therapy and chemotherapy have been considered standard treatment option in this disease. This particularly became evident when radical thoracic radiation therapy was combined with concurrent platinum-etoposide chemotherapy. Prophylactic cranial irradiation was also shown to be important part of the overall treatment approach and is suggested as standard treatment option in the last decade. Several questions, however, remained in focus of clinical investigations in the recent decades with no clear answers provided. In particular, investigators embarked on evaluating the timing of administration of radiation therapy and chemotherapy in combined modality approach. Several prospective randomized trials and several meta-analyses showed that there is an advantage for early administration of the two modalities, especially using concurrent approach. While landmark Intergroup study clearly showed benefit of BID fractionation over QD fractionation, two ongoing studies further built on the question of optimization of dose and fractionation issue in this setting. Finally, issue of tumor volumes to be used during the radiation therapy course remain suboptimally investigated due to lack of clinical studies investigating it and, therefore, poor guidelines for daily clinical practice.