Abstract
Limited-stage (LS) small-cell lung cancer (SCLC) is defined as disease confined to a tolerable radiation portal without extrathoracic metastases. Despite clinical research over two decades, the prognosis of LS-SCLC patients remains poor. The current standard of care for LS-SCLC patients is concurrent platinum-based chemotherapy with thoracic radiotherapy (RT). Widespread heterogeneity on the optimal radiation dose and fractionation regimen among physicians highlights the logistical challenges of administering BID regimens. Prophylactic cranial irradiation (PCI) is recommended to patients following a good initial response to chemoradiation due to improved overall survival from historical trials and the propensity for LS-SCLC to recur with brain metastases. However, PCI utilization is being debated due to the greater availability of magnetic resonance imaging (MRI) and data in extensive-stage SCLC regarding close MRI surveillance in lieu of PCI while spurring novel RT techniques, such as hippocampal-avoidance PCI. Additionally, novel treatment combinations incorporating targeted small molecule therapies and immunotherapies with or following radiation for LS-SCLC have seen recent interest and some concepts are being investigated in clinical trials. Here, we review the landscape of progress, limitations, and challenges for LS-SCLC including current standard of care, novel radiation techniques, and the integration of novel therapeutic strategies for LS-SCLC.
Highlights
Small-cell lung cancer (SCLC) is a subtype of lung cancer accounting for 13–15% of all lung cancer patients [1,2]
The authors show that Limited-stage SCLC (LS-SCLC) patients who received Intensity Modulated Radiation Therapy (IMRT) required significantly fewer percutaneous feeding tube insertions compared to those who received 3D conformal radiation therapy (3DCRT) (5% vs. 17%) but there were no differences in outcomes between these two techniques [33]
Given that SCLC is generally considered to be more radiosensitive compared to NSCLC, the combination of Stereotactic Body Radiation Therapy (SBRT) and chemotherapy may be an option for the 5% of patients that present with clinical stage I SCLC, evidence is currently sparse [35]
Summary
Small-cell lung cancer (SCLC) is a subtype of lung cancer accounting for 13–15% of all lung cancer patients [1,2]. The current standard of care for the treatment of LS-SCLC is platinum-based chemotherapy with early concurrent thoracic radiation therapy followed by prophylactic cranial irradiation (PCI) for LS-SCLC patients with good response to initial treatment [4]. Two meta-analyses published in 1992 established concurrent chemoradiation improved OS and local disease control [8,9] The larger of these meta-analyses, by Pignon et al [9], included 13 clinical trials and 2140 LS-SCLC patients with a median follow up of 43 months showed chemoradiation improved OS at 3 years by 5.4% compared to chemotherapy solely [9]. A meta-analysis by Fried et al evaluated the use of early versus late delivery of thoracic radiotherapy to LS-SCLC patients. Seven randomized controlled trials were evaluated which collectively showed 5% OS benefit at 2-years for early radiotherapy [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
