Small Cell Lung Cancer
Small Cell Lung Cancer is a topic covered in the Pearson's General Thoracic.
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Key Point
- Small cell lung cancer (SCLC) represents approximately 15% of lung cancer cases.
- SCLC is generally divided into two functional stages, limited (LS-SCLC) and extensive (ES-SCLC). Limited-stage is disease confined to a single radiation port – within one hemithorax with or without involvement of lymph nodes in the mediastinum. Extensive stage is disease beyond those confines, generally outside the chest or with contralteal chest involvement. LS-SCLC median overall survival is 20 months, 1-year survival 60%, 5-year survival 20%. ES-SCLC median overall survival is 10 months, 1-year survival 30%, 5-year survival 1%. In the 8th edition of the AJCC staging manual, TNM staging is now applied to small cell lung cancer but most clinicians continue to use the old system.
- The standard treatment for LS-SCLC is combination chemotherapy (e.g. etoposide/platinum) and concurrent chest radiotherapy, followed by PCI in responding patients; this is associated with a long-term survival rate of 15% to 20%. Stage I(small tumor, node negative) cases can be approached with surgical resection followed by adjuvant systemic chemotherapy with four cycles of cisplatin and etoposide.
- Standard therapy for ES-SCLC is systemic chemotherapy (e.g., four to six cycles of etoposide/platinum); patients with an excellent response may be considered for PCI and consolidative thoracic radiotherapy.
- Despite high response rates to initial chemotherapy and radiation, more than 80% of patients relapse and die within 1 to 2 years.
- Patients with resected SCLC, any stage, should be offered adjuvant chemotherapy (e.g., four cycles of etoposide/platinum).
- Median survival time at relapse after first line therapy is approximately 6 months.
- Second-line chemotherapy (e.g., topotecan, CAV, temozolamide) can prolong survival and improve symptoms.
- Future directions for second line systemic therapy include immunotherapy with combination PD-1 and CTLA-4 inhibitors.
- Surgical intervention is rarely considered in the management of SCLC, but there are several instances where surgery may be indicated, including in stage I disease, for mixed-histology tumors (10%-15%), for second primary tumors (often non-SCLC), and for large, isolated and symptomatic brain metastases.
- Age alone should not be a primary determinant in the decision to treat. Fit, older patients should be considered candidates for combination chemotherapy and thoracic radiation.
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Key Point
- Small cell lung cancer (SCLC) represents approximately 15% of lung cancer cases.
- SCLC is generally divided into two functional stages, limited (LS-SCLC) and extensive (ES-SCLC). Limited-stage is disease confined to a single radiation port – within one hemithorax with or without involvement of lymph nodes in the mediastinum. Extensive stage is disease beyond those confines, generally outside the chest or with contralteal chest involvement. LS-SCLC median overall survival is 20 months, 1-year survival 60%, 5-year survival 20%. ES-SCLC median overall survival is 10 months, 1-year survival 30%, 5-year survival 1%. In the 8th edition of the AJCC staging manual, TNM staging is now applied to small cell lung cancer but most clinicians continue to use the old system.
- The standard treatment for LS-SCLC is combination chemotherapy (e.g. etoposide/platinum) and concurrent chest radiotherapy, followed by PCI in responding patients; this is associated with a long-term survival rate of 15% to 20%. Stage I(small tumor, node negative) cases can be approached with surgical resection followed by adjuvant systemic chemotherapy with four cycles of cisplatin and etoposide.
- Standard therapy for ES-SCLC is systemic chemotherapy (e.g., four to six cycles of etoposide/platinum); patients with an excellent response may be considered for PCI and consolidative thoracic radiotherapy.
- Despite high response rates to initial chemotherapy and radiation, more than 80% of patients relapse and die within 1 to 2 years.
- Patients with resected SCLC, any stage, should be offered adjuvant chemotherapy (e.g., four cycles of etoposide/platinum).
- Median survival time at relapse after first line therapy is approximately 6 months.
- Second-line chemotherapy (e.g., topotecan, CAV, temozolamide) can prolong survival and improve symptoms.
- Future directions for second line systemic therapy include immunotherapy with combination PD-1 and CTLA-4 inhibitors.
- Surgical intervention is rarely considered in the management of SCLC, but there are several instances where surgery may be indicated, including in stage I disease, for mixed-histology tumors (10%-15%), for second primary tumors (often non-SCLC), and for large, isolated and symptomatic brain metastases.
- Age alone should not be a primary determinant in the decision to treat. Fit, older patients should be considered candidates for combination chemotherapy and thoracic radiation.
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Last updated: September 23, 2021
Citation
Sabari, Joshua K, et al. "Small Cell Lung Cancer." Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book, Chicago: Society of Thoracic Surgeons, 2021. STS Cardiothoracic Surgery, ebook.sts.org.
Sabari JK, Leighl NB, Shepherd FA, Rudin CM. Small Cell Lung Cancer. In: Darling GE, Baumgartner WA, Jacobs JP, eds. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2021. ebook.sts.org. Accessed August 19, 2022.
Sabari, J. K., Leighl, N. B., Shepherd, F. A., & Rudin, C. M. (2021). Small Cell Lung Cancer. In Darling, G., Baumgartner, W., & Jacobs, J. (Eds.), Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons. ebook.sts.org
Sabari JK, Leighl NB, Shepherd FA, Rudin CM. Small Cell Lung Cancer [Internet]. In: Darling GE, Baumgartner WA, Jacobs JP, editors. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2021. [cited 2022 August 19]. Available from: ebook.sts.org.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Small Cell Lung Cancer
ID - 1418471
ED - Jacobs,J,
ED - Darling,Gail,
ED - Baumgartner,William,
Y1 - 2021/09/23/
BT - Pearson's General Thoracic
UR - https://ebook.sts.org/sts/view/Pearsons-General-Thoracic/1418471/3.2/Small_Cell_Lung_Cancer
PB - Chicago: Society of Thoracic Surgeons
DB - STS Cardiothoracic Surgery
DP - Unbound Medicine
ER -