Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

Abstract

In the U.S., the prevalence of small cell lung cancer (SCLC) is declining, probably reflecting the decreasing prevalence of tobacco use. However, a significant number of patients will receive a diagnosis of SCLC, and approximately 40% of patients with SCLC will have limited-stage (LS) disease, which is potentially curable with the combination of chemotherapy and radiation therapy. The standard therapy for LS-SCLC is concurrent chemoradiotherapy, and the 5-year survival rate observed in clinical trials is approximately 25%. The standard chemotherapy remains cisplatin and etoposide, but carboplatin is frequently used in patients who cannot tolerate or have a contraindication to cisplatin. Substantial improvements in survival have been made through improvements in radiation therapy. Concurrent chemoradiotherapy is the preferred therapy for patients who are appropriate candidates. The optimal timing of concurrent chemoradiotherapy is during the first or second cycle, based on data from meta-analyses. The optimal radiation schedule and dose remain topics of debate, but 1.5 Gy twice daily to a total of 45 Gy and 1.8 -2.0 Gy daily to a total dose of 60 -70 Gy are commonly used treatments. For patients who obtain a near complete or complete response, prophylactic cranial radiation reduces the incidence of brain metastases and improves overall survival. The ongoing Radiation Therapy Oncology Group and Cancer and Leukemia Group B and the European and Canadian phase III trials will investigate different radiation treatment paradigms for patients with LS-SCLC, and completion of these trials is critical.

New insights into stage and prognosis in small cell lung cancer: an analysis of 968 cases

“…In the beginning, chest irradiation in SCLC was broad and covered the entire mediastinum. Currently, with further technical progresses, radiation field is limited and toxicity decreased (26). A phase III study performed in 471 patients with limited SCLC (27) showed that 5-year survival increased with radiotherapy given twice-daily (1.5 Gy, 30 fractions) compared with once-daily (1.8 Gy daily in 25 fractions) (P=0.04).…”

Relationship Between the SER Treatment Period and Prognosis of Patients with Small Cell Lung Cancer

“…Survival benefit that radiotherapy intervention was carried out on the first day or 22 days of chemotherapy (early radiotherapy) in patients was superior to that of radiotherapy intervention was implemented on the first 36 days or 106 days of chemotherapy (late radiotherapy): median survival time was respectively 21.2 months vs.16 months (p=0.008) and 34 months vs 26 months (p=0.052) (Murray et al, 2003;Jeremic et al, 2007). However, unfortunately, the other Phase III clinical studies did not obtain the consistent results (Stinchcombe et al, 2010). Currently, the results of phase III clinical studies are not all transformed to operational guidelines, then whether the Meta-analysis based on above data can provide some valuable information?…”

“…2 important meta analysis had confirmed that chest radiotherapy can not only reduce the local recurrence rate, but also can improve the survival rate of the patients. Therefore, systemic chemotherapy and local accelerated hyperfractionated thoracic radiotherapy had became the standard treatment for small cell lung cancer for it could significantly improve local control rate, prolong the survival time of patients, and patients could well tolerate the treatment side effects (Stinchcombe et al, 2010;Kalemkerian et al, 2011;Amini et al, 2014). Prophylactic cranial irradiation (PCI) is recommended for patients achieving a complete response (CR) due toNowadays, the golden treatment for LD-SCLC is concurrent chemoradiotherapy, but the precise intervention time of radiotherapy is still inconclusive (Manapov et al, 2013).…”

Effect of radiotherapy on the treatment of patients with extensive stage small cell lung cancer

“…Although the timing of radiation therapy continues to be debated, the 2011 NCCN guidelines in SCLC state that there is category 1 evidence to support concurrent chemoradiotherapy over sequential therapy for fit patients (Stinchcombe and Gore, 2010;Komatsu et al, 2011;NCCN, 2011).…”