Management of small cell lung cancer: current state of the art

Small cell lung cancer (SCLC) is a common malignancy that is rapidly fatal if left untreated, with most patients surviving < 6 months. Currently, patients with SCLC are treated with chemotherapy with or without thoracic radiotherapy. Randomized trials have demonstrated the superiority of multiagent regimens over single-agent therapies, with the combination of cisplatin and etoposide being the initial regimen of choice for most patients, regardless of stage at presentation. Dose escalation, weekly chemotherapy, alternating noncross-resistant chemotherapy, and maintenance chemotherapy have been evaluated in SCLC, with no convincing data to date demonstrating an advantage for these strategies over conventional treatment strategies. Second-line therapy may be effective in selected patients, depending on the interval between primary treatment and recurrence, response to primary therapy, and the agents used for initial treatment. Radiotherapy is generally accepted as an essential component of optimal management of limited-stage disease, although sequencing, timing, fractionation, dose, and field size remain less than adequately defined. Finally, the routine use of prophylactic cranial irradiation remains controversial, and currently should be reserved for patients in complete remission.