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Small Cell Lung Cancer

Joshua K. Sabari, Natasha B. Leighl, Frances A. Shepherd, Charles M. Rudin
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: March 20, 2020