Current concepts in the management of small cell carcinoma of the lung

Small cell carcinoma of the lung should be viewed as a widely disseminated disease in all patients. Therefore, systemic treatment with intensive combination chemotherapy should now be considered as the primary and initial treatment modality. The role of radiation therapy for local or involved-field needs to be re-examined to determine if such localized therapy following intensive combination chemotherapy offers any benefits in response rate or survival duration. The role of immunotherapy is not established, and further controlled studies are necessary to define such a role, if any does exist. Prophylactic whole brain irradiation may be useful to avoid neurologic complications, however, it does not appear to improve response rate or survival duration. A randomized study needs to be done to see whether prophylactic whole brain irradiation following complete remission alters the occurrence rate of brain metastases. Response rates up to 100% and disease free survivals greater than one year have been reported. Therefore, a realistic potential for cure exists for some patients with this particular type of lung cancer.