Small cell lung cancer (CPC) -: Management of patients presenting with limited stage small cell carcinoma of the lung

Small cell carcinomas represent less than 20% of all lung cancer. Only a third of these patients present with limited stage disease. Treatment is based on a combination of chemotherapy and radiotherapy including a platinum salt with or without another drug. Conformational thoracic radiotherapy is administered either classically fractionated or in an accelerated form. Prophylactic cranial irradiation is indicated in patients with a good response. An improvement in outcomes has been obtained with this regimen. Even in limited stage disease 5 year survival remains about 25% in the best series. The majority of patients will relapse and the risk of cerebral metastases is particularly high, reaching nearly 50% at 2 years even in patients with a complete response. Prophylactic cranial irradiation should be part of the standard management of patients with a complete response on the basis of a meta analysis showing a 5% increase in survival at three years. Even though combination treatments have improved survival, a number of questions remain that should stimulate further clinical trials to establish the optimum regimes of chemotherapy and radiotherapy and the optimum strategies for combining the two. In addition the potential role of targeted therapy in selected patients must be examined.