Small Cell Lung Cancer
- 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 contralateral chest involvement. LS-SCLC median overall survival is 20 months, 1-year survival 60%, 5-year survival 20%. ES-SCLC median overall survival is 13 months, 1-year survival 54%, 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 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 cycles of etoposide/platinum) with immunotherapy (anti-PD-L1 antibodies atezolizumab or durvalumab) followed by maintenance immunotherapy.
- 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, lurbinectedin, CAV, temozolomide) can prolong survival and improve symptoms.
- 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 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: July 13, 2022
Sabari, Joshua K, et al. "Small Cell Lung Cancer." Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book, Chicago: Society of Thoracic Surgeons, 2022. STS 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; 2022. ebook.sts.org. Accessed June 7, 2023.
Sabari, J. K., Leighl, N. B., Shepherd, F. A., & Rudin, C. M. (2022). 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; 2022. [cited 2023 June 07]. 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 - 2022/07/13/ BT - Pearson's General Thoracic UR - https://ebook.sts.org/sts/view/Pearsons-General-Thoracic/1418471/all/Small_Cell_Lung_Cancer PB - Chicago: Society of Thoracic Surgeons DB - STS Surgery DP - Unbound Medicine ER -