Chemotherapy is used in combination with radiation treatment for limited disease small cell lung cancer (SCLC-LD), and alone for extensive disease small cell lung cancer (SCLC-ED). Response is expected in about 90% and 50% of the patients, respectively. Ten to 15% of patients with localized cancer and 1-2% of patients with extensive cancer will live for more than 5 years.
In patients with T1-2N0-1 disease, surgical treatment may be appropriate. It is assumed that up to 10% of patients with localized cancer may be candidates for a successful resection. Postoperative chemotherapy is required since small cell lung cancer are at high-risk to metastasize, also in early stage.
First choice chemotherapy for localized cancer, and in younger patients (< 75 years) with extensive cancer, is platinum and etoposide. Cistplatin seems superior to carboplatin combined with radiation treatment. In extensive disease, carboplatin might be chosen due to less toxicity and ease of administration.
About 80% of patients with limited cancer and virtually all with extensive cancer will have recurrence of the disease. A few phase II-studies have been presented in the second line setting of SCLC. Topoisomerase inhibitors (irinotecan/topotecan) and the triple-combination with cyclophosphamide, vincristin and doxorubicin has shown activity and might be used. The expected treatment benefit must be weighed against the patient's general health status and expected survival time. For relapse three months or more after ended first line treatment, it may be appropriate to try the same regimen again. For early recurrence, another chemotherapy regimen should be considered. Radiation therapy will often provide successful symptom relief and may be considered instead of chemotherapy.
Chemotherapy for reduced general health condition and elderly patients with small cell lung cancer
Even patients with reduced general health status due to localized cancer, can achieve significant benefit from treatment. The goal is curative also for these patients. If the reduced status of the patient is due to another illness, the treatment chosen should have few side effects.
For extensive cancer, the threshold for treatment should be higher, especially in older patients or patients with reduce general health status. It should be considered whether active treatment should be given at all.
- For localized cancer, the treatment is intended to cure the disease.
- For extensive cancer, the treatment is primarily palliative.