treatment

Last reviewed 01/2018

  • 70% of patients have extensive disease at time of diagnosis
  • approximately 75% of patients respond to combination chemotherapy which can induce temporary remission and increase life expectancy
  • in patients with limited disease, thoracic radiotherapy used in conjunction with chemotherapy can improve survival
  • the risk of brain metastases can be reduced with the use of prophylactic radiotherapy in patients who respond to chemotherapy

NICE recommend (1):

  • offer all SCLC patients multidrug platinum-based chemotherapy
  • if the disease responds, offer four to six cycles of chemotherapy. Maintenance treatment is not recommended
  • if limited-stage SCLC then offer thoracic irradiation concurrently with the first or second cycle of chemotherapy or after completion of chemotherapy if there has been at least a good partial response within the thorax
  • if extensive disease then consider thoracic irradiation after chemotherapy if there has been a complete response at distant sites and at least a good partial response within the thorax
  • prophylactic cranial irradiation should be considered for patients with limited disease and complete or good partial response after primary treatment
  • for most cases treatment is palliative
    • radiotherapy may be used to ease pain or bronchial obstruction and pleurodesis may be indicated for recurrent pleural effusions
    • palliative endoscopic laser therapy of obstructive lesions of large airways may also be effective
  • if recurrent small cell lung cancer
    • NICE state that (2):
      • oral topotecan is recommended as an option only for people with relapsed small-cell lung cancer for whom:
        • re-treatment with the first-line regimen is not considered appropriate and
        • the combination of cyclophosphamide, doxorubicin and vincristine (CAV) is contraindicated
      • intravenous topotecan is not recommended for people with relapsed small-cell lung cancer

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