Treatment of limited disease small cell lung cancer

Limited disease small cell lung cancer (LD-SCLC) is a heterogeneous disease, not only for its clinical behavior, but also for is anatomical extension. In very rare, early cases, LD-SCLC might be treated with surgery and chemotherapy, but as the overwhelming majority of patients present with locally advanced disease, the standard of care is concurrent chest radiotherapy with cisplatin and etoposide chemotherapy followed by prophylactic cranial irradiation (PCI). Newer chemotherapeutic drugs as well as targeted agents have not improved the outcome thus far. Given concurrently with chest irradiation, cisplatin combined with etoposide, administered every 21 days for 4-5 cycles have frequently been used. Thoracic radiotherapy should begin as early as possible during the first chemotherapy cycle. A total radiation dose of 45 Gy is recommended, delivered in a short overall treatment time (less than 4 weeks). Accelerated therapy increased absolute 5-year survival rates by 10% compared to longer treatment times, at the expense of an incidence of severe esophagitis of approximately 30%, which is reversible within a few weeks. Hematological complications and late pulmonary damage may occur, but is not more frequent than with less intensive schedules that impair long-term survival. Obviously, patient selection is crucial. Because after combined chemotherapy and thoracic radiotherapy, the remission status of the tumor is difficult to assess because of radiation-induced radiographic changes, patients that show no tumor progression are suitable for PCI. With this treatment, 5-year survival rates of 25% can be achieved in patients with LD-SCLC.