Updated January 2014
The prognosis of limited stage SCLC patients that receive no therapy is poor with a median survival of only 10-12 weeks. The median survival of patients treated with radiotherapy alone is 5-6 months and long term survivors are uncommon (1-2%). Combined modality therapy as recommended by the BCCA Lung Tumour Group increases the median survival to 18 to 24 months and the probability of long-term (5-year) survival is 20-25%.
Treatment Modalities for Limited SCLC
Guideline: Limited stage small cell lung cancer patients should receive treatment with curative intent combining thoracic irradiation with chemotherapy.
Level of Evidence: I
Meta-analyses of sixteen randomized trials comparing chemotherapy alone versus chemotherapy plus thoracic irradiation for limited stage SCLC demonstrated a highly significant survival benefit for combined modality therapy (Payne, 1992, Pignon 1992). As soon as the diagnosis of limited SCLC is assigned, patients should have consultation from both medical and radiation oncologists for planning of integrated therapy. Since this is a curable neoplasm, therapy should be given according to a published protocol or a clinical trial rather than assembled in an arbitrary fashion. The treatment plan should be commenced without unnecessary delay.
Patients with extensive disease by regional extension (pleural effusion, pericardial effusion, contralateral supraclavicular nodes and equivocal distant disease) should be given the benefit of the doubt with respect to combined modality therapy. Regional radiotherapy may be delayed until the effusions are controlled. The other cautionary note is patients with negative conventional staging but a PET scan demonstrating a small amount of extra-thoracic disease. It may not be appropriate to deny these patients combined modality therapy.
References:
1. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited stage small-cell lung carcinoma of the lung? A meta-analysis. J Clin Oncol 1992;10:890-895.
2. Pignon JP, Arriagada R, Ihde DC, et al. A meta-analysis of thoracic radiotherapy for small cell lung cancer. N Engl J Med 1992;327:1618.
