[Prognostic factors and therapeutic strategies in small cell bronchial carcinoma]

Small cell lung cancer (SCLC) is considered as a disseminated disease in most cases. Staging is important to define whether the patient has limited disease and should stop after diagnosis of extensive disease, unless the patient is part of a staging or therapy protocol. Assessment of other prognostic factors, like performance status, tumour spread, age, sex, tumour response and laboratory results (LDH, AP, Albumin, Sodium, NSE, CEA) is important especially for stratification of randomised trials. Untreated the median survival is 6-8 weeks. At least initially SCLC is very sensitive to chemotherapy like cyclophosphamide, doxorubicin and vincristin (VAC) or cisplatin and etoposide (EP) and the median survival is increased to 10-14 months. Symptomatic relief is often dramatically with 70-80% of patients obtaining relief within one month of starting chemotherapy. Radiotherapy improves local tumour control. Surgery should be done if a R0-resection seems to be possible. The value of high dose chemotherapy with stem cell support is tested in current clinical trials.