Treatment of limited small cell lung cancer: an old or new challenge?

This review highlights how progress has been made in treating limited small cell lung cancer and outlines current challenges to overcome for improved cure rates.

There is a rationale for the tumour, node, metastasis staging system to replace the current convention of limited versus extensive stage. Positron emission tomography may aid in staging but prospective validation in larger series of patients is needed. Cisplatin and etoposide chemotherapy has yet to be superseded by either newer cytotoxic drugs or targeted agents. More progress has been made for radiotherapy but questions of optimal dose, schedule, timing and treatment volume remain unanswered.

Concurrent chemoradiotherapy is associated with a one in four chance of cure. Two ongoing phase III trials have been designed to address the optimal radiotherapy regimen to combine with cisplatin and etoposide. Close collaboration between radiation and medical oncologists is needed to make further progress and to improve patient access to curative intent concurrent chemoradiotherapy regimens.